2nd Department of Anaesthesiology, Medical School, University of Athens, Attikon Hospital, Greece.
Acta Anaesthesiol Scand. 2011 Jul;55(6):740-8. doi: 10.1111/j.1399-6576.2011.02461.x. Epub 2011 May 25.
The immunomodulatory effects of volatile anaesthetics in vitro and the protective effect of propofol in lung injury spurred us to study the effects of volatile anaesthetics and propofol on lung tissue in vivo.
Twenty-seven pigs were randomized to 4-h general anaesthesia with propofol (8 mg/kg/h, group P, n=9), sevoflurane [minimum alveolar concentration (MAC)=1.0, group S, n=9) or desflurane (MAC=1.0, group D, n=9). Four healthy animals served as the no-ventilation group. Bronchoalveolar lavage fluid (BALF) was obtained to measure the cell counts, platelet-activating factor acetylhydrolase (PAF-AcH), phospholipase A(2) (PLA(2)) and superoxide dismutase (SOD) activity. Lung tissues were evaluated histologically and for caspase-3 expression.
Volatile anaesthetics reduced PAF-AcH levels without affecting PLA(2) activity and resulted in decreased alveolar macrophage and increased lymphocyte counts in BALF (sevoflurane: 29 ± 23%; desflurane: 26 ± 6%, both P<0.05 compared with 4 ± 2% in the no-ventilation group). These findings were accompanied by atelectasis and inflammatory cells' infiltration in the inhalational anaesthetics groups. Also, sevoflurane reduced SOD activity and both sevoflurane and desflurane induced significant caspase-3 expression. In contrast, propofol resulted in a minor degree of inflammation and preserved BALF cells' composition without triggering apoptosis.
Halogenated anaesthetics seem to trigger an immune lymphocytic response in the lung, inducing significant apoptosis and impairment of PAF-AcH. In contrast, propofol preserves anti-inflammatory and anti-oxidant defences during mechanical ventilation, thus preventing the emergence of apoptosis.
挥发性麻醉剂在体外的免疫调节作用以及异丙酚在肺损伤中的保护作用促使我们研究挥发性麻醉剂和异丙酚对体内肺组织的影响。
27 头猪随机分为 4 小时全身麻醉组（异丙酚 8mg/kg/h，P 组，n=9）、七氟醚（最低肺泡有效浓度（MAC）=1.0，S 组，n=9）或地氟醚（MAC=1.0，D 组，n=9）。4 头健康动物作为未通气组。收集支气管肺泡灌洗液（BALF）以测量细胞计数、血小板激活因子乙酰水解酶（PAF-AcH）、磷脂酶 A₂（PLA₂）和超氧化物歧化酶（SOD）活性。评估肺组织的组织学和半胱天冬酶-3 表达。
挥发性麻醉剂降低 PAF-AcH 水平而不影响 PLA₂ 活性，并导致 BALF 中肺泡巨噬细胞减少和淋巴细胞计数增加（七氟醚：29±23%；地氟醚：26±6%，均 P<0.05 与未通气组的 4±2%相比）。这些发现伴随着吸入麻醉剂组的肺不张和炎症细胞浸润。此外，七氟醚降低了 SOD 活性，七氟醚和地氟醚均诱导了显著的半胱天冬酶-3 表达。相比之下，异丙酚导致炎症程度较轻，并维持 BALF 细胞组成而不触发细胞凋亡。
卤代麻醉剂似乎在肺中引发免疫淋巴细胞反应，诱导显著的细胞凋亡和 PAF-AcH 损伤。相比之下，异丙酚在机械通气过程中保持抗炎和抗氧化防御，从而防止细胞凋亡的发生。
