BACKGROUND: Lung resection surgery is associated with an inflammatory reaction. The use
of 1-lung ventilation (OLV) seems to increase the likelihood of this reaction. Different prophylactic
and therapeutic measures have been investigated to prevent lung injury secondary to OLV.
Lidocaine, a commonly used local anesthetic drug, has antiinflammatory activity. Our main goal
in this study was to investigate the effect of IV lidocaine on tumor necrosis factor α (TNF-α) lung
expression during lung resection surgery with OLV.
METHODS: Eighteen pigs underwent left caudal lobectomy. The animals were divided into 3
groups: control, lidocaine, and sham. All animals received general anesthesia. In addition, animals
in the lidocaine group received a continuous IV infusion of lidocaine during surgery (1.5
mg/kg/h). Animals in the sham group only underwent thoracotomy. Samples of bronchoalveolar
lavage (BAL) fluid and plasma were collected before initiation of OLV, at the end of OLV, at the
end of surgery, and 24 hours after surgery. Lung biopsy specimens were collected from the left
caudal lobe (baseline) before surgery and from the mediastinal lobe and the left cranial lobe
24 hours after surgery. Samples were flash-frozen and stored to measure levels of the following
inflammatory markers: interleukin (IL) 1β, IL-2, IL-10, TNF-α, nuclear factor κB, monocyte chemoattractant
protein-1, inducible nitric oxide synthase, and endothelial nitric oxide synthase.
Markers of apoptosis (caspase 3, caspase 9, Bad, Bax, and Bcl-2) were also measured. In addition,
levels of metalloproteinases and nitric oxide metabolites were determined in BAL fluid and
in plasma samples. A nonparametric test was used to examine statistical significance.
RESULTS: OLV caused lung damage with increased TNF-α expression in BAL, plasma, and lung
samples. Other inflammatory (IL-1β, nuclear factor κB, monocyte chemoattractant protein-1)
and apoptosis (caspase 3, caspase 9, and BAX) markers were also increased. With the use
of IV lidocaine there was a significant decrease in the levels of TNF-α in the same samples
compared with the control group. Lidocaine administration also reduced the inflammatory and
apoptotic changes observed in the control group. Hemodynamic values, blood gas values, and
airway pressure were similar in all groups.
CONCLUSIONS: Our results suggest that lidocaine can prevent OLV-induced lung injury through
reduced expression of proinflammatory cytokines and lung apoptosis. Administration of lidocaine
may help to prevent lung injury during lung surgery with OLV. (Anesth Analg 2014;119:815–28)