Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

Abstract

BACKGROUND Patients experiencing acute lung injury (ALI) often need mechanical ventilation for which sedation may be required. In such patients, usually the first choice an intravenously administered drug. However, growing evidence suggests that volatile anesthetics such as sevoflurane are a valuable alternative. In this study, we evaluate pulmonary and systemic effects of long-term (24-hour) sedation with sevoflurane compared with propofol in an in vivo animal model of ALI. METHODS Adult male Wistar rats were subjected to ALI by intratracheal lipopolysaccharide (LPS) application, mechanically ventilated and sedated for varying intervals up to 24 hours with either sevoflurane or propofol. Vital parameters were monitored, and arterial blood gases were analyzed. Inflammation was assessed by the analysis of bronchoalveolar lavage fluid (BALF), cytokines (monocyte chemoattractant protein-1 [MCP-1], cytokine-induced neutrophil chemoattractant protein-1 [CINC-1], interleukin , IL-12/12a, transforming growth factor-, and IL-10) in blood and lung tissue and inflammatory cells. The alveolocapillary barrier was indirectly assessed by wet-to-dry ratio, albumin, and total protein content in BALF. Results are presented as mean ± standard deviation. RESULTS After 9 hours of ventilation and sedation, oxygenation index was higher in the LPS/sevoflurane (LPS-S) than in the LPS/propofol group (LPS-P) and reached 400 ± 67 versus 262 ± 57 mm Hg after 24 hours (P < .001). Cell count in BALF in sevoflurane-treated animals was lower after 18 hours (P = .001) and 24 hours (P < .001) than in propofol controls. Peak values of CINC-1 and IL-6 in BALF were lower in LPS-S versus LPS-P animals (CINC-1: 2.7 ± 0.7 vs 4.0 ± 0.9 ng/mL; IL-6: 9.2 ± 2.3 vs 18.9 ± 7.1 pg/mL, both P < .001), whereas IL-10 and MCP-1 did not differ. Also messenger RNAs of CINC-1, IL-6, IL-12a, and IL-10 were significantly higher in LPS-P compared with LPS-S. MCP-1 and transforming growth factor-showed no differences. Wet-to-dry ratio was lower in LPS-S (5.4 ± 0.2 vs 5.7 ± 0.2, P = .016). Total protein in BALF did not differ between P-LPS and S-LPS groups. CONCLUSIONS Long-term sedation with sevoflurane compared with propofol improves oxygenation and attenuates the inflammatory response in LPS-induced ALI. Our findings suggest that sevoflurane may improve lung function when used for sedation in patients with ALI. Bacterial lipopolysaccharides (LPSs) are complex glycolipids found on the outer membrane of Gram-negative bacteria 10 and have been utilized to examine in vitro and in vivo inflammatory responses. [10][11][12] Other markers of ALI include endothelial barrier disruption, recruitment and transmigration of neutrophils, and development of a protein-and neutrophil-rich (noncardiogenic) pulmonary edema. [13][14][15][16] According to current guidelines, intravenous propofol, midazolam, and dexmedetomidine are recommended for sustained sedation in critically ill patients. 17,18 However, since the introduction of the Anaesthetic Conserving Device (AnaConDa; S...

Sevoflurane Dampens Acute Pulmonary Inflammation via the Adenosine Receptor A2B and Heme Oxygenase-1

“…Our study detected an elevated expression of tight junction proteins and improved microvascular permeability after sevoflurane treatment, highlighting the protective properties of the anesthetic agent during the acute inflammatory response. In line with our results, recent studies demonstrated that sevoflurane administration improved the microvascular permeability during cerebral ischemia and lung injury [ 63 , 64 ].…”

Comparing The Efficacy of Sevoflurane To Propofol For Inflammatory Response During Venovenous Extracorporeal Membrane Oxygenation

“…Herein, results showed that sevo urane signi cantly reduced the in ltration of pulmonary neutrophils during VV-ECMO-assisted ARDS. Previous experimental studies have shown that reducing in ammation of the lungs could improve pulmonary oxygenation function and pulmonary edema [27]. Our results showed that rats in the sevo urane treatment group had less lung tissue pathological damage and lower W/D ratio compared to rats in the propofol group, suggesting that sevo urane was superior to propofol in improving the oxygenation function and hemodynamic stability.…”

“…In recent years, several studies have con rmed that sedative drugs can reduce lung in ammation during the sedation of ARDS patients [25,26]. Sevo urane is a commonly used inhalation anesthetic whose antiin ammatory properties have been demonstrated in LPS-induced lung injury, whereas propofol is a commonly used intravenous anesthetic in clinical practice [27]. Studies have revealed that the protective effect of propofol on lung tissue is associated with oxidative stress and in ammatory response.…”

Clostridium butyricum B1 alleviates high‐fat diet‐induced steatohepatitis in mice via enterohepatic immunoregulation

“…This may be attributed to the various sources of IL‐10 that makes it a challenging task to regulate the IL‐10 expression. Moreover, IL‐10 was dynamically expressed during different phase of diseases . INF‐γ and TGF‐β, as well as TLR4‐Myd88 pathway, were involved in the promotion of IL‐10 expression, which were significantly decreased in the HFD + CB group compared with the HFD group .…”