title: Nitric oxide and endothelin-1 release after one-lung ventilation during thoracoabdominal esophagectomy.
abstract: One-lung ventilation (OLV) is applied during esophagectomy to improve exposure during the thoracic part of the operation. Collapse of lung tissue, shunting of pulmonary blood flow, and changes in alveolar oxygenation during and after OLV may possibly induce an ischemia-reperfusion response in the lung, which may affect the pulmonary endothelium. Such a reaction might thereby contribute to the frequently occurring respiratory complications among these patients. In this small trial, 30 patients were randomized to either OLV (n= 16) or two-lung ventilation (TLV, n= 14) during esophagectomy. Central venous and arterial plasma samples were taken before and after OLV/TLV for analysis of nitrite and a metabolite of nitric oxide (NO), and also during the 1st, 2nd, 3rd, and 10th postoperative day for analysis of endothelin, another endothelium-derived vasoactive mediator. Lung biopsies were taken before and after OLV or TLV, and analyzed regarding immunofluorescence for isoform of NO synthase, a protein upregulated during inflammatory response and also vascular congestion. No changes in lung isoform of NO synthase immunofluorescence or vascular congestion were registered after neither OLV nor TLV. Plasma nitrite and endothelin levels were similar in the two study groups. We conclude that OLV does not seem to have any influence on key regulators of pulmonary vascular tone and inflammation, i.e. NO and endothelin. From this perspective, OLV seems to be a safe method, which defends its clinical position to facilitate surgical exposure during thoracoabdominal esophagectomy.
authors.affiliation: Division of Anaesthesia, Department of Medicine Solna, CLINTEC, Karolinska Institute, Stockholm, Sweden Division of Surgery, Department of Medicine Solna, CLINTEC, Karolinska Institute, Stockholm, Sweden Pharmacology Unit, Department of Medicine Solna, CLINTEC, Karolinska Institute, Stockholm, Sweden Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden Department of Oncology, Gothenburg University, Gothenborg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Lund
authors.forename: L
authors.initials: L
authors.lastname: Ny
authors.forename: R E
authors.initials: RE
authors.lastname: Malmström
authors.forename: J O
authors.initials: JO
authors.lastname: Lundberg
authors.forename: Å
authors.initials: Å
authors.lastname: Öst
authors.forename: M
authors.initials: M
authors.lastname: Björnstedt
authors.forename: L
authors.initials: L
authors.lastname: Lundell
authors.forename: J A
authors.initials: JA
authors.lastname: Tsai
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015331:Cohort Studies; D019332:Endothelin-1 / Q000378:metabolism*; D004938:Esophageal Neoplasms / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000378:metabolism; D055370:Lung Injury / Q000209:etiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism*; D061810:One-Lung Ventilation / Q000009:adverse effects / Q000379:methods*; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism*; D012121:Respiration, Artificial / Q000379:methods
chemical_list: D015415:Biomarkers; D019332:Endothelin-1; D009569:Nitric Oxide; C496319:NOS2 protein, human; D052247:Nitric Oxide Synthase Type II