Immunomodulatory effect of propofol versus sevoflurane in patients undergoing thoracic surgery using one lung ventilation technique

Introduction: One lung ventilation [OLV] has become a standard procedure for many interventions in thoracic surgery with a need for deflation of the lung to facilitate the surgical procedure. Mechanical ventilation can induce a proinflammatory reaction in the non-deflated ventilated lung. However only limited data exist on inflammatory alterations in the temporarily deflated, non-ventilated lung in patients undergoing thoracic surgery

Aim of the work: The aim of this work is to compare between the effects of propofol and sevoflurane as regards: the systemic inflammatory response, the pulmonary inflammatory response, C-reactive protein, leucocyte count, and recovery status, in patients undergoing thoracic surgery using OLV technique

Patients and methods: This study include 40 adult patients, who were randomly classified into two groups: group [I] 20 patients received total intravenous anesthesia with propofol. Group [II] 20 patients received inhalational anesthesia with sevoflurane. Every patient was subjected to a careful pre-anaesthetic assessment, anaesthesia, bronchoalveolar lavage [BAL] analysis for human inflammatory mediators [IL-6 and TNF-alpha], serum analysis for systemic inflammatory mediators [IL-6 and TNF-alpha] [Both were measured before OLV and 15 min after OLV ended and resumption of two lung ventilation [TLV] at the end of surgery, and C-reactive protein and leukocyte count in blood [before OLV, 15 min after OLV ended and resumption of [TLV] at the end of surgery and on the 2nd postoperative day]

Results: According to IL-6 and TNF-alpha, there was no statistically significant difference between the two groups before OLV, however they were significantly increased in both groups in serum and BAL after OLV in relation to before OLV with significant increase in group I relative to group II. A significant correlation was present between increased level of IL-6 and TNF-alpha in BAL and their levels in serum after OLV in the group II but this correlation was not present in the group I. Also no significant correlation between duration of OLV and inflammatory mediators [IL-6 and TNF-alpha] in serum and BAL in both groups. As regarding to CRP, there was no statistically significant difference between the two groups before OLV. After OLV and on the 2nd postoperative day the level of CRP increased significantly in both groups with significant increase in group I relative group II. According to WBC count there was no statistically significant difference between the two groups as regards the level of WBC before OLV. After OLV the level of WBC increased significantly in group I only. On the 2nd postoperative day the level of WBC increased significantly in both groups with significant increase in group I relative to group II. Also no significant correlation between duration of OLV with the increased levels of CRP and WBC count in both groups

Conclusion: Propofol increased pulmonary and systemic cytokine release more than sevoflurane during OLV. Propofol has increased CRP level and WBC count more than sevoflurane during OLV

Comparative effect of hypertonic saline and mannitol on intracranial pressure, electrolyte changes and some haemodynamic functions in brain tumour surgery

This work was done on 20 adults patients scheduled for elective brain surgery to compare the effects of hypertonic saline 7.5% [in a dose of 4 ml/kg infused over 10 minutes] and mannitol 20% [in a dose of 1 g/kg]. It was found that hypertonic saline improved circulation by plasma volume expansion with significant increase in MABP and CVP and significant increase in AMBP and CVP and reduction of brain bulk more than mannitol. Serum sodium and osmolality was elevated more with hypertonic saline than in mannitol, while serum potassium was more maintained with hypertonic saline than with mannitol. Urine output increased gradually in hypertonic saline, while in mannitol, there was rapid diuresis. Hypertonic saline is recommended to be a safe method for reduction of ICP