Background: Although one-lung ventilation (OLV) has become
an established procedure during thoracic surgery, sparse
data exist about inflammatory alterations in the deflated, reventilated
lung. The aim of this study was to prospectively investigate
the effect of OLV on the pulmonary inflammatory response
and to assess possible immunomodulatory effects of the anesthetics
propofol and sevoflurane.
Methods: Fifty-four adults undergoing thoracic surgery with
OLV were randomly assigned to receive either anesthesia with
intravenously applied propofol or the volatile anesthetic
sevoflurane. A bronchoalveolar lavage was performed before
and after OLV on the lung side undergoing surgery. Inflammatory
mediators (tumor necrosis factor
, interleukin 1, interleukin
6, interleukin 8, monocyte chemoattractant protein 1)
and cells were analyzed in lavage fluid as the primary endpoint.
The clinical outcome determined by postoperative adverse
events was assessed as the secondary endpoint.
Results: The increase of inflammatory mediators on OLV was
significantly less pronounced in the sevoflurane group. No difference
in neutrophil recruitment was found between the
groups. A positive correlation between neutrophils and mediators
was demonstrated in the propofol group, whereas this
correlation was missing in the sevoflurane group. The number
of composite adverse events was significantly lower in the
sevoflurane group.
Conclusions: This prospective, randomized clinical study
suggests an immunomodulatory role for the volatile anesthetic
sevoflurane in patients undergoing OLV for thoracic surgery
with significant reduction of inflammatory mediators and asignificantly better clinical outcome (defined by postoperative adverse events) during sevoflurane anesthesia.

Background. Primary graft dysfunction (PGD) is a predominant cause of early morbidity and
mortality after lung transplantation. Although substantial work has been done to understand risk factors for PGD in terms of donor, recipient, and surgical factors, little is understood regarding the potential role of anaesthetic management variables in its development.
Methods. We conducted a retrospective exploratory analysis of 107 consecutive lung transplants to determine if anaesthesia factors were associated with early graft function quantified by PaO2/FIO2. Multivariate regression techniques were used to explore the association between anaesthetic management variables and PaO2/FIO2 ratio 12 h after operation. The relationship between these variables and both time to tracheal extubation and intensive care unit (ICU) length of stay was further examined using the Cox proportional hazards.
Results. On multivariate analysis, increasing volume of intraoperative colloid, comprising predominantly Gelofusinew (succinylated gelatin), was independently associated with a lower PaO2/FIO2 12 h post-transplantation [b coefficient 242 mm Hg, 95% confidence interval (CI) 27 to 277 mm Hg, P¼0.02] and reduced rate of extubation [hazard ratio (HR) 0.65, 95% CI 0.49–0.84, P¼0.001]. There was a trend for intraoperative colloid to be associated with a reduced rate of ICU discharge (HR 0.79, 95% CI 0.31–1.02, P¼0.07).
Conclusions. We observed an inverse relationship between volume of intraoperative colloid
and early lung allograft function. The association persists, despite detailed sensitivity analyses and adjustment for potential confounding variables. Further studies are required to confirm these findings and explore potential mechanisms through which these associations may act.