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Randomized Controlled Trial
. 2014 Dec;55(6):628-37.
doi: 10.3325/cmj.2014.55.628.

Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation

Iztok Potočnik  1 , Vesna Novak Janković, Maja Šostarič, Ales Jerin, Tomaž Štupnik, Milan Skitek, Jasmina Markovič-Božič, Tomislav Klokočovnik
Affiliations
Randomized Controlled Trial

Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation

Iztok Potočnik et al. Croat Med J. 2014 Dec.

Abstract

Aim: To prospectively assess the antiinflammatory effect of volatile anesthetic sevoflurane in patients undergoing open lung surgery with one lung ventilation (OLV).

Methods: This prospective, randomized study included 40 patients undergoing thoracic surgery with OLV (NCT02188407). The patients were randomly allocated into two equal groups that received either propofol or sevoflurane. Four patients were excluded from the study because after surgery they received blood transfusion or non-steroid antiinflammatory drugs. Inflammatory mediators (interleukins 6, 8, and 10, C-reactive protein [CRP], and procalcitonin) were measured perioperatively. The infiltration of the nonoperated lung was assessed on chest x-rays and the oxygenation index was calculated. The major postoperative complications were counted.

Results: Interleukin 6 levels were significantly higher in propofol than in sevoflurane group (P=0.014). Preoperative CRP levels did not differ between the groups (P=0.351) and in all patients they were lower than 20 mg/L, but postoperative CRP was significantly higher in propofol group (31±6 vs 15±7 ng/L; P=0.035); Pre- and postoperative procalcitonin was within the reference range (<0.04 µg/L) in both groups. The oxygenation index was significantly lower in propofol group (339±139 vs 465±140; P=0.021). There was no significant difference between the groups in lung infiltrates (P=0.5849). The number of postoperative adverse events was higher in propofol group, but the difference was not-significant (5 vs 1; P=0.115).

Conclusion: The study suggests an antiinflammatory effect of sevoflurane in patients undergoing thoracotomy with OLV.

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Figures

Figure 1
Figure 1
Flow diagram of the study.
Figure 2
Figure 2
Interleukin 6 (IL 6), Interleukin 8 (IL 8), and Interleukin 10 (IL 10) levels. Time points: 1. Insertion of the retractor, 2. Beginning of one-lung ventilation, 3. End of surgery, 4. Six hours after surgery.
Figure 3
Figure 3
Oxygen delivery index (Do2I) (mL/min/m2). Time points: 1. Before induction, 2. After insertion of the retractor, 3. After the start of one-lung ventilation, 4. At the end of surgery, 5. Six hours after surgery. Repeated-measures ANOVA.
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