Lung injury following thoracic aortic occlusion: comparison of sevoflurane and propofol anaesthesia

• Published in: Acta anaesthesiologica Scandinavica Vol. 52; no. 7; pp. 977 - 986
• Main Authors: ANNECKE, T., KUBITZ, J. C., LANGER, K., HILBERATH, J. M., KAHR, S., KROMBACH, F., BITTMANN, I., REHM, M., KEMMING, G. I., CONZEN, P. F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2008; Blackwell
• Subjects: anaesthetics i.v; anaesthetics volatile; Anesthesia; Anesthesia - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - therapeutic use; Anesthetics, Intravenous - therapeutic use; Animals; Aorta, Thoracic - physiopathology; aortic clamping; Arterial Occlusive Diseases - complications; Biological and medical sciences; Blood Flow Velocity - drug effects; Blood Pressure - drug effects; Disease Models, Animal; ischaemia-reperfusion injury; Lung - blood supply; Lung - drug effects; Lung - pathology; Lung damage; Medical sciences; Methyl Ethers - therapeutic use; Propofol - therapeutic use; Reperfusion Injury - prevention & control; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory Distress Syndrome, Adult - prevention & control; Severity of Illness Index; Swine; Time Factors; Vascular Resistance - drug effects; Volatile compound; Lung disease; Lung damage; Respiratory disease; Ischemia reperfusion; aortic clamping; ischaemia-reperfusion injury; Sevoflurane; anaesthetics i.v; General anesthetic; Anesthesia; Aorta; Propofol; Comparative study; anaesthetics volatile; Halogen Organic compounds
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2008.01665.x

Background: Halogenated anaesthetics have been shown to reduce ischaemia–reperfusion injuries in various organs due to pre‐ and post‐conditioning mechanisms. We compared volatile and total intravenous anaesthesia with regard to their effect on remote pulmonary injury after thoracic aortic occlusion and reperfusion. Methods: Eighteen pigs were randomized after sternotomy and laparotomy (fentanyl–midazolam anaesthesia) to receive either sevoflurane or propofol in an investigator‐blinded fashion. Ninety minutes of thoracic aortic occlusion was induced by a balloon catheter. During reperfusion, a goal‐directed resuscitation protocol was performed. After 120 min of reperfusion, the anaesthetic regimen was changed to fentanyl–midazolam again for another 180 min. The oxygenation index and intra‐pulmonary shunt fractions were calculated. After 5 h of reperfusion, a bronchoalveolar lavage was performed. The total protein content and lactate dehydrogenase activity were measured in epithelial lining fluid (ELF). Alveolar macrophage oxidative burst was analysed. The wet to dry ratio was calculated and tissue injury was graded using a semi‐quantitative score. Ten animals (n=5 for each anaesthetic) without aortic occlusion served as time controls. Results: The oxygenation index decreased and the intra‐pulmonary shunt fraction increased significantly in both occlusion groups. There were no significant differences between sevoflurane and propofol with respect to the oxygenation index, ELF composition, morphologic lung damage, wet to dry ratio and alveolar macrophage burst activity. Differences were, however, seen in terms of systemic haemodynamic stability, where catecholamine requirements were less pronounced with sevoflurane. Conclusion: We conclude that the severity of remote lung injury was not different between sevoflurane and propofol anaesthesia in this porcine model of severe lower‐body ischaemia and reperfusion injury.