The effects of sevoflurane on systemic and pulmonary inflammatory responses after cardiopulmonary bypass.
OBJECTIVE
During reperfusion after cardiopulmonary bypass, leukocytes are retained in the lungs. The purpose of this study was to examine the effect of sevoflurane on the inflammatory responses of the lungs after cardiopulmonary bypass.


METHODS
A prospective, randomized clinical investigation.


METHODS
A university hospital.


METHODS
Thirty patients undergoing valve replacement surgery using cardiopulmonary bypass.


METHODS
Fifteen patients in whom anesthesia was maintained with sevoflurane and the priming solution was saturated with sevoflurane were randomly assigned to the sevoflurane group. Similarly, 15 patients in whom anesthesia was maintained with sufentanil and the priming solution was mixed with sufentanil were randomly assigned to the sufentanil group


RESULTS
After induction, an arterial blood sample was obtained for the baseline leukocyte count. Blood was collected from the pulmonary artery (PA) and vein (PV) before cardiopulmonary bypass and 10 minutes after the restoration of heart beats. The leukocyte count, levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-alpha were measured. The PV/PA ratio of each parameter was determined for the assessment of inflammatory response of the lung. The leukocyte counts and plasma levels of cytokines increased more in the sufentanil group than the sevoflurane group. The PV/PA ratio of neutrophils decreased after the restoration of heart beats in the sufentanil group but was unchanged in the sevoflurane group. The PV/PA ratio of IL-6 was higher in the sufentanil group. The PV/PA ratio of interleukin-8 and interleukin-10 increased after the restoration of the pulmonary circulation in the sufentanil group but decreased in the sevoflurane group. The PV/PA ratio of tumor necrosis factor alpha increased in the sufentanil group but remained unchanged in the sevoflurane group.


CONCLUSIONS
Sevoflurane attenuates the pulmonary sequestration of neutrophil and leukocytes and also preserves the pulmonary consumption of cytokines at the time of early pulmonary reperfusion. Sevoflurane attenuates the systemic inflammatory response induced by cardiopulmonary bypass.
Department of Anesthesiology and Pain Medicine, Incheon St Mary's Hospital, Catholic University of Korea, Medical College, Incheon, Korea.
Eun Jung
EJ
Cho
Jong Hyun
JH
Yoon
Sung Jin
SJ
Hong
Sun Hee
SH
Lee
Sung Bo
SB
Sim
D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane