Phase 1 Study of Antiinflammatory Effect of Sevoflurane in Open Lung Surgery With One-Lung Ventilation

Lung injury is the main complication of open lung surgery and is associated with a very high mortality rate.

In 1984, Zeldin reported on ten patients with a complication that he referred to as postpneumonectomy pulmonary oedema (PLE). The complication is sometimes not easy to differentiate from acute respiratory distress syndrome (ARDS), defined by Bernard et al, because the patients may not fulfill all the ARDS criteria. The incidence of this so-called acute lung injury (ALI) after lobectomy is 1-7%. The mortality rate in patients with ARDS and ALI is 72% and 33%, respectively.

In patients undergoing lung resection, mechanical ventilation and surgery may induce alveolar and systemic inflammatory responses. One-lung ventilation (OLV) has become as a standard procedure for many interventions in thoracic surgery with a need for deflation of the lung to facilitate the surgical procedure. It is also the main cause of acute inflammatory response and is associated with ALI and ARDS. The inflammatory reaction produces injury to the lung endothelium. The loss of endothelium integrity causes increased protein leak into the alveolar fluid. The inflammatory reaction leads to other histological changes. These reactions during OLV have been reported by many investigators.

A number of studies have shown that sevoflurane attenuates cardiac ischaemia-reperfusion injury. These results have been lately transferred to lung surgery. Some studies have demonstrated that volatile anaesthetics sevoflurane, isoflurane and desflurane have an impact on ischaemic-reperfusion lung injury. These studies have confirmed the local alveolar, but not the systemic antiinflammatory effects of sevoflurane.

Studies to date have not evaluated long-lasting effects of anaesthetics administered intraoperatively.