To evaluate the effects of inhalation sevoflurane in the early ischemia and reperfusion on pulmonary inflammatory response in patients undergoing cardiac surgery with extracorporeal circulation (ECC).

Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into 2 groups (20 patients in each group): control group and sevoflurane group. In sevoflurane group, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and also before and after the ascending aorta was opened. Paitents in control group didn′t inhale sevoflurane. Time was defined as the followings: after anesthesia and before skin incision (T₀), immediately before ECC (T₁), immediately after ECC (T₂), 2 h after ECC (T₃), 6 h after ECC (T₄) and 24 h after ECC (T₅). At T₀, T₂, T₃, T₅, the radial artery blood was obtained to detect the levels of plasma tumor necrosis factor-α(TNF-α), interleukin-8(IL-8) and soluble intercellular adhesion molecule-1(sICAM-1). At T₁, T₂, the pulmonary artery and pulmonary vein blood was obtained to detect the neutrophil count and calculate the differences between the vein and artery. At T₀, T₂, T₃, T₄, T₅, the arterial blood gas was detected and differences of alveoli-arterial oxygen pres [P_(A-a)O₂], oxygenation index (OI), static compliance (Cst) were calculated.

The levels of plasma TNF-α, IL-8 and sICAM-1 were higher at T₂, T₃, T₅ than those at T₀ in two groups (P<0.05). The levels of plasma TNF-α, IL-8 and sICAM-1 were decreased in sevoflurane group at T₂ and T₃, compared with those in control group (P<0.05). The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were higher at T₂ than those at T₀ in two groups (P<0.05). The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were decreased in sevoflurane group at T₂ compared with those of control group (P<0.05). The level of P_(A-a)O₂ was higher at T₂, T₃, T₄ and T₅ than that at T₀ in two groups (P<0.05). The level of OI was decreased at T₂, T₃, T₄ and T₅ compared with that at T₀ in two groups (P<0.05). The level of Cst was decreased at T₂, T₃ and T₄ compared with that at T₀ in two groups (P<0.05). The level of P_(A-a)O₂ was decreased in sevoflurane group at T₂, T₃ and T₄ compared with that in control group (P<0.05). The levels of OI and Cst were higher in sevoflurane group at T₂, T₃ and T₄ compared with those in control group (P<0.05).

Severe pulmonary inflammation often occurs during cardiac surgery with ECC, and it can be relieved by inhalation of sevoflurane in the early ischemia and reperfusion.

Extracorporeal circulation; Sevoflurane; Inflammatory response