Sevoflurane Ameliorates Gas Exchange and Attenuates Lung Damage in Experimental Lipopolysaccharide-induced Lung Injury

Voigtsberger, Stefanie; Lachmann, Robert; Leutert, A. C.; Schläpfer, Martin; Booy, Christa; Reyes, Livia; Urner, Martin; Schild, Julia; Schimmer, Ralph C.; Beck‐Schimmer, Beatrice

doi:10.1097/aln.0b013e3181bdf857

Cited by 104 publications

(100 citation statements)

References 54 publications

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Section: Discussionmentioning

confidence: 99%

“…In a 2009 study, Voigtsberger et al 12 observed improved oxygenation and attenuated inflammatory response in an LPS-induced ALI rat model after 6 hours when sevoflurane was used rather than propofol. Ferrando et al 28 endorsed the results of Voigtsberger et al 12 in a porcine 2-hit ARDS model. In addition, the anti-inflammatory effects of volatile anesthetics in the deflated-reventilated lung undergoing hypoxia-reoxygenation could also be verified in clinical investigations: De Conno et al 29 found that sevoflurane reduced pulmonary inflammatory response and chemoattraction of neutrophils in patients undergoing 1-lung ventilation for lung resection.…”

Section: Discussionmentioning

confidence: 99%

“…9 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.…”

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confidence: 99%

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

Kellner

Müller

Piegeler

et al. 2017

Survey of Anesthesiology

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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. A cute lung injury (ALI) frequently requires both mechanical ventilation and sedation in the intensive care unit (ICU). 1,2 Currently, approximately 10% of patients treated in the ICU experience ALI or acute respiratory distress syndrome (ARDS), 3 and mortality rates of up to 50% have been described. 4 Immune activation and a massive release of proinflammatory mediators are hallmarks of ALI and ARDS, 5 and mechanical ventilation may further exacerbate the inflammatory response. 6-8 Cytokines recruit effector cells, which amplify the inflammatory response. 9 Bacterial lipopolysaccharides (LPSs) are complex glycolipids found on the outer membrane of Gr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Kellner

Müller

Piegeler

et al. 2017

Survey of Anesthesiology

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“…Compared with controls under propofol anesthesia, inhaled anesthetics result in attenuation of cytokine elevations in both the ventilated and the operative lung [ 41 ]. This approach appears to translate into better outcomes, as patients in the sevofl urane arm experienced less composite adverse events [ 42 ]. Pressure-supported ventilation with PEEP is more likely to maintain optimal lung volumes during emergence.…”

Section: Mechanical Ventilationmentioning

confidence: 99%

One-Lung Ventilation in Anesthesia

Rocca

Vetrugno

2016

Topical Issues in Anesthesia and Intensive Care

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“…For example, Suter et al have recently shown that, in an in vitro model of endotoxin-induced lung injury, production of inflammatory proteins is attenuated in alveolar epithelial cells following sevoflurane preconditioning (30). Post-conditioning with sevoflurane attenuates lung damage and preserves lung function in in vivo and in vitro models of acute respiratory distress syndrome (ARDS) (29,32). Additionally, Conno et al showed that patients who received sevoflurane while undergoing one-lung ventilation for thoracic surgery experienced a significant reduction in inflammatory mediators and significantly better clinical outcomes than patients who received propofol (2).…”

mentioning

confidence: 99%

Changes in microRNA expression in rat lungs caused by sevoflurane anesthesia: a TaqMan^|^reg; low-density array study

Tanaka¹,

Ishikawa²,

Arai³

et al. 2012

Biomed. Res.

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Reportedly, a large number of microRNAs (miRNAs) play an important role in inflammatory lung diseases such as asthma, idiopathic pulmonary fibrosis (IPF), acute respiratory distress syndrome (ARDS), and pulmonary arterial hypertension (PAH). Sevoflurane is routinely used to various patients, and its safety has been confirmed by clinical outcomes; however, its effects to lungs at the miRNA level have not been elucidated. In our previous genomic studies, we showed that sevoflurane anesthesia affected the expression of many genes and mRNAs in rat lungs. In this study, we comprehensively investigated changes in miRNA expression caused by sevoflurane anesthesia (2.0% and 4.0%). Sevoflurane anesthesia resulted in apparent changes in miRNA expression in rat lungs, and the pattern of 2.0% sevoflurane-induced changes in miRNA expression was similar to that of 4.0% sevoflurane. Some of the differentially expressed miRNAs are known to be involved in asthma, IPF, and PAH. Especially, miR-146a, the most up-regulated miRNA, is known to attenuate the toxic effects associated with LPS stimulation. We showed, for the first time, dynamic changes in miRNA expression caused by sevoflurane anesthesia, and moreover, our results were important to understand the influence of sevoflurane anesthesia on any patients suffered from various lung diseases.

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Sevoflurane Ameliorates Gas Exchange and Attenuates Lung Damage in Experimental Lipopolysaccharide-induced Lung Injury

Abstract: Postconditioning with sevoflurane attenuates lung damage and preserves lung function in an in vivo model of acute lung injury.

Cited by 104 publications

References 54 publications

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

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

One-Lung Ventilation in Anesthesia

Changes in microRNA expression in rat lungs caused by sevoflurane anesthesia: a TaqMan^|^reg; low-density array study

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