Sevoflurane decreases systemic inflammatory response in lung resection surgery and one lung ventilation in an animal experimental model

Objective: Inflammatory cytokines are increased during one-lung ventilation in patients undergoing lung resection, and this increase can be fatal. Propofol and sevoflurane are the main anesthetics used for these patients. Unfortunately, there is no consensus on the best choice of an anesthetic agent concerning an inflammatory response in patients undergoing lung resection. This meta-analysis aimed to compare the effects of propofol and sevoflurane on the inflammatory response in patients undergoing lung resection.Methods: We searched electronic databases to identify randomized controlled trials comparing the effects of different anesthetics (sevoflurane vs. propofol) on the inflammatory response. The primary outcome concerned the concentration of systemic inflammatory cytokines. The secondary outcomes concerned the concentrations of inflammatory cytokines in the bronchoalveolar lavage (BAL) fluid from the dependent and independent lung. Random effects analysis of the meta-analyses were performed to synthesize the evidence and to assess the concentrations of inflammatory factors in the sevoflurane and propofol groups.Results: Eight trials involving 488 participants undergoing lung resection with one-lung ventilation were included. There was no significant difference in the concentrations of systemic interleukin (IL)-6, IL-10, or tumor necrosis factor α between the sevoflurane and propofol groups. Compared with the propofol group, BAL levels of IL-6 in the dependent ventilated lung were decreased in the sevoflurane group (three trials, 256 participants; standardized mean difference [SMD], −0.51; 95% confidence interval [CI], −0.90 to −0.11; p = 0.01; I2 = 46%). The BAL levels of IL-6 in the independent ventilated lung were also decreased by sevoflurane (four trials, 362 participants; SMD, −0.70; 95% [CI], −0.93 to −0.47; p < 0.00001; I2 = 0%).Conclusions: There was no difference in the systemic inflammatory response between the sevoflurane and propofol groups. However, compared with propofol, sevoflurane can reduce the local alveolar inflammatory response. Additional research is necessary to confirm whether the inflammatory response is direct or indirect.

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Inflammatory Response After One-lung Ventilation According to Ventilation Methods

Case Medical Research ◽

10.31525/ct1-nct04007354 ◽

2019 ◽

Author(s):

Keyword(s):

Inflammatory Response ◽

Lung Ventilation ◽

One Lung Ventilation

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Response to: ‘Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomised controlled trial comparing intravenous and inhalational anaesthesia’

British Journal of Anaesthesia ◽

10.1016/j.bja.2017.12.016 ◽

2018 ◽

Vol 120 (2) ◽

pp. 411-412 ◽

Cited By ~ 1

Author(s):

E. Murphy ◽

B. Shelley

Keyword(s):

Randomised Controlled Trial ◽

Inflammatory Responses ◽

Controlled Trial ◽

Lung Resection ◽

Lung Ventilation ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

One Lung Ventilation ◽

Inhalational Anaesthesia ◽

Randomised Controlled

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Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection

Journal of Thoracic Disease ◽

10.21037/jtd.2018.03.50 ◽

2018 ◽

Vol 10 (3) ◽

pp. 1864-1874 ◽

Cited By ~ 3

Author(s):

Silvia Fiorelli ◽

Veronica Defraia ◽

Fabiola Cipolla ◽

Cecilia Menna ◽

Mohsen Ibrahim ◽

...

Keyword(s):

Inflammatory Cytokine ◽

Lung Resection ◽

Lung Ventilation ◽

Cytokine Response ◽

Short Term ◽

One Lung Ventilation ◽

Inflammatory Cytokine Response

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Anesthetic-induced Improvement of the Inflammatory Response to One-lung Ventilation

Anesthesiology ◽

10.1097/aln.0b013e3181a10731 ◽

2009 ◽

Vol 110 (6) ◽

pp. 1316-1326 ◽

Cited By ~ 167

Author(s):

Elisena De Conno ◽

Marc P. Steurer ◽

Moritz Wittlinger ◽

Marco P. Zalunardo ◽

Walter Weder ◽

...

Keyword(s):

Clinical Outcome ◽

Adverse Events ◽

Inflammatory Response ◽

Thoracic Surgery ◽

Inflammatory Mediators ◽

Volatile Anesthetic ◽

Lung Ventilation ◽

One Lung Ventilation ◽

Sevoflurane Group ◽

Randomized Clinical Study

Background Although one-lung ventilation (OLV) has become an established procedure during thoracic surgery, sparse data exist about inflammatory alterations in the deflated, reventilated lung. The aim of this study was to prospectively investigate the effect of OLV on the pulmonary inflammatory response and to assess possible immunomodulatory effects of the anesthetics propofol and sevoflurane. Methods Fifty-four adults undergoing thoracic surgery with OLV were randomly assigned to receive either anesthesia with intravenously applied propofol or the volatile anesthetic sevoflurane. A bronchoalveolar lavage was performed before and after OLV on the lung side undergoing surgery. Inflammatory mediators (tumor necrosis factor alpha, interleukin 1beta, interleukin 6, interleukin 8, monocyte chemoattractant protein 1) and cells were analyzed in lavage fluid as the primary endpoint. The clinical outcome determined by postoperative adverse events was assessed as the secondary endpoint. Results The increase of inflammatory mediators on OLV was significantly less pronounced in the sevoflurane group. No difference in neutrophil recruitment was found between the groups. A positive correlation between neutrophils and mediators was demonstrated in the propofol group, whereas this correlation was missing in the sevoflurane group. The number of composite adverse events was significantly lower in the sevoflurane group. Conclusions This prospective, randomized clinical study suggests an immunomodulatory role for the volatile anesthetic sevoflurane in patients undergoing OLV for thoracic surgery with significant reduction of inflammatory mediators and a significantly better clinical outcome (defined by postoperative adverse events) during sevoflurane anesthesia.

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