Effect of anesthetic factors on perioperative inflammatory responses in bilateral lung transplantation: advantages of dexmedetomidine-based anesthesia

Abstract

Objective To evaluate the effect of anesthetic factors on perioperative inflammatory responses in bilateral lung transplantation. Methods Fifty-six American Society of Anesthesiologists physical status Ⅲ or Ⅳpatients, aged 18-64 yr, weighing 45-65 kg, undergoing elective bilateral lung transplantation, were divided into 2 groups(n=28 each)using a random number table: routine anesthesia group(group R)and dexmedetomidine-based anesthesia group(group D). In group D, dexmedetomidine was intravenously infused as a dose of 1.0 μg/kg for 10 min followed by an infusion of 0.5 μg·kg-1·h-1, propofol 4-6 mg·kg-1·h-1, cisatracurium besylate 0.05 mg·kg-1·h-1 and remifentanil 0.1-0.3 μg·kg-1·min-1 were intravenously infused and 1%-2% sevoflurane was inhaled.In group R, the method for anesthesia maintenance was similar to that previously described in group D except dexmedetomidine.Before anesthesia induction, immediately after intubation, immediately after one-lung ventilation, at 30 and 60 min after one-lung ventilation, immediately after two-lung ventilation, at 30 and 60 min after two-lung ventilation, at the end of surgery and at 12 and 24 h after surgery(T0-10), blood samples were collected from the radial artery for determination of serum tumor necrosis factor-alpha, interleukin-6(IL-6)and IL-8 levels by enzyme-linked immunosorbent assay.The extubation time was recorded. Results The serum concentrations of tumor necrosis factor-alpha, IL-6 and IL-8 were significantly lower at T3-10, and the extubation time was shorter in group D than in group R(P<0.05). Conclusion Dexmedetomidine-based anesthesia can decrease perioperative inflammatory responses and is helpful in improving prognesis in the patients undergoing bilateral lung transplantation. Key words: Dexmedetomedine; Lung transplantation; Systemic inflammatory response syndrome