Abstract
Objective: To observe the effect of sevoflurane preconditioning on inflammatory cytokines and oxygen radicals during single lung ventilation (SLV) in patients with lung cancer and to discuss the mechanism of sevoflurane induced lung protection. Methods: Thirty patients, ASA I or II, with non-small-cell lung cancer underwent pulmonary surgeries were randomized into two groups: sevoflurane preconditioning group (group S, n=15) and control group (group C, n=15). After general anaesthesia induction. A double-lumen tube was placed and the position was checked by a fibre optic bronchoscope. During the mechanical ventilation, patients in group S, received sevoflurane at 1.0 minimum alveolar concentration (MAC) for 30 min as a preconditioning and then replaced by oxygen for a complete rapid gas exchange to reduce the sevoflurane inhalation concentration to 0 before SLV. While in group C, only intravenous anaesthetic agents, fentanyl and propofol, were administrated before SLV. Blood concentrations of TNF-α, IL-6, IL-8, SOD and MDA were measured at Post-induction of anaesthesia (T1), 30 min after SLV in the lateral position (T2), 60 min after SLV in the lateral position (T3), and at the end of the operation (T4). Results: When compared with Tl, the concentrations of TNF-α, IL-6 and MDA in both groups and the IL-8 in group S were significantly increased at T2-T4 (P<0.05), while the expression of SOD in two groups were decreased significantly(P<0.05). The concentrations of TNF-α, IL-6, IL-8 and MDA in group S were decreased significantly at T2-T4 (P<0.05 or P<0.01) when compared with those in group C. The activity of SOD in group S was significantly increased at T3 and T4 (P<0.05). Conclusion: Sevoflurane preconditioning may moderate the release of inflammatory cytokines to inhibit the inflammatory reaction and may reduce the lipid peroxidation by inhibiting the generation of oxygen free radical. It may protect the lung from the injury during SLV.
Highlights
Single lung ventilation (SLV) is a common way of ventilation, with its application in lung cancer surgery, lung injury caused by SLV has raised widely attention
This study aim to observe the sevoflurane preconditioning in patients with lung cancer underwent SLV and the influence of inflammatory cytokines and oxygen free radicals, investigate the lung protection mechanism of sevoflurane
Weight 70.7 ± 10.8 67.6 ± 9.4 mediators, including the release of IL-6, IL-8, start the inflammatory cascade reaction, induction of neutrophil degranulation and the endothelial cell adhesion, IL-6 is strongest in former inflammatory cytokines, inflammatory mediators related to the strict degree of tissue damage and duration, [1] reflect the operation stress caused by the severity of the inflammatory response, IL-8 is acknowledged as the inflammatory reaction in the specific cytokines lead to lung tissue damage, the white blood cells have strong chemotaxis
Summary
Single lung ventilation (SLV) is a common way of ventilation, with its application in lung cancer surgery, lung injury caused by SLV has raised widely attention. Sevoflurane is a type of inhalation anaesthetics medicine, it is features for rapid awakening and easy to control, has been widely used in recent years. Studies have shown that sevoflurane pre-treatment could have effect of lung protective, think that inhaled sevoflurane pre-treatment can reduce the lungs injury, protect lung function in patients with lung cancer during SLV. Oxygen free radicals and inflammatory cytokines plays an important role in the lung injury. This study aim to observe the sevoflurane preconditioning in patients with lung cancer underwent SLV and the influence of inflammatory cytokines and oxygen free radicals, investigate the lung protection mechanism of sevoflurane
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