Effects of sevoflurane versus propofol anesthesia on inflammatory response and pulmonary function during perioperative period in patients undergoing lung cancer resection

Abstract

Objective To compare the effects of sevoflurane and propofol anesthesia on inflammatory response and pulmonary function during perioperative period in patients undergoing lung cancer resection．Methods Thirty ASA Ⅰ or Ⅱ patients(23 male，7 female) aged 41-64 yr having a body weisht index of 22-30 kg/m2 undegoing elective left lower lobe resection were randomly divided into 2 groups(n=15 each)：sevoflurane group (group S) and propofol group(group P)．Anesthesia was induced with 6％-8％ sevoflurane or propofol 2 mg/kg and fentanyl 4-6 μg/kg．Intubation with double lumen catheter was facilitated with vecuroniunl 0．1 mg/kg． Anesthesia was maintained with 1％-3％ sevoflurane/propofol infusion(6-10 mg·kg-1·h-1)and intermittent iv boluses of fentanyl and vecuronium．Radial artery was cannulated．Swan-Ganz catheter was placed via right internal jugular vein．The patients were mechanically ventilated．During one lung ventilation(OLV)I：E and VT were adjusted to maintain airway pressure <30 cm H2O．Arlerial and mixed venous blood samples were collected for blood gas analysis before induction of anesthesia(T0)，before OLV(T1)，at the end of OLV(T2)，when the chest was closed(T3) and at 24 h after operation (T4)．PA-aO2，Qs/Qt and respiratory index(RI，PA-aO2/PaO2) were calculated. Serum matrix metallo-proteinase-9 (MMP-9) and MDA were measured at T0, T3 and T4. Dynamic lung compliance (Cd) was calculated at T1-3 .Results PA-aO2, RI and Qs/Qt at T1-3 and serum MMP-9 and MDA concentrations at T3 were significantly increased as compared with the baseline values at T0 in both groups. In group S, Cd was significantly lower at T3 than at T1.PA-AO2, and serum MMP-9 and MDA concentrations at T3, RI at T2,3 and Qs/Qt at T1-3 were significantly higher in group S than in group P. Conclusion The inflammatory response is lower and the injury to pulmonary function is lighter during propofol anesthesia than sevoflurane anesthesia in patients undergoing lung cancer resection. Key words: Anesthetics, inhalation; Propofol; Inflammation; Respiratory function tests; Lung neoplasms