Anesthetics to Prevent Lung Injury in Cardiac Surgery

Phase 1

Completed

Conditions: Inflammatory Lung Injury
Ischemia-Reperfusion Lung Injury
Postoperative Pulmonary Complications

Brief Summary: The purpose of this study is to investigate whether the use of inhaled anesthetics, compared to intravenous anesthetics, can affect the amount of lung inflammation and postoperative respiratory complications seen after cardiac surgery.

Detailed Description: Randomized, controlled trial involving 45 adult patients undergoing cardiac surgery with cardiopulmonary bypass. Patients will be randomized to receive either inhaled anesthesia with sevoflurane or total intravenous anesthesia (TIVA) with propofol for the maintenance phase of their cardiac anesthetic. Assessment of lung inflammation will take place using fiberoptic bronchoscopic sampling of lung fluid as well as serum collection before and after exposure to cardiopulmonary bypass, and the incidence of compositive postoperative pulmonary complications will take place in the postoperative period.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Emergency surgery
History of severe COPD, emphysema, or ILD
Recent (<2wk) or current use of systemic glucocorticoids
Prior history of pneumothorax
Allergy/contraindication to intravenous anesthetics
Personal or family history of malignant hyperthermia or high risk for malignant hyperthermia

Arm && Interventions

Group	Intervention	Description
Inhaled Anesthesia	Sevoflurane	Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass.
Intravenous Anesthesia	Propofol	Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass.

Primary Outcome Measures

Name	Time	Method
Bronchoalveolar Lavage (BAL) Concentration of TNF Alpha (pg/mL)	Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass	Inflammatory mediator found in BAL fluid during lung inflammation

Secondary Outcome Measures

Name	Time	Method
Number of Patients With Postoperative Pulmonary Complications	Assessed daily, beginning on the first day after surgery, until hospital discharge or death. On average at our institution, most patients are discharged within 7 days so this is the expected time frame for follow up.	Composite endpoint of clinically relevant pulmonary complications
BAL Concentration of IL1b (pg/mL)	Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass	Inflammatory mediator found in BAL fluid during lung inflammation
BAL Concentration of IL6 (pg/mL)	Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass	Inflammatory mediator found in BAL fluid during lung inflammation
BAL Concentration of IL8 (pg/mL)	Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass	Inflammatory mediator found in BAL fluid during lung inflammation
BAL Concentration of MCP1 (pg/mL)	Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass	Inflammatory mediator found in BAL fluid during lung inflammation
BAL Concentration of sRAGE (pg/mL)	Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass	Biomarker of lung injury (RAGE - receptor for advance glycosylation end products)