ORIGINAL ARTICLE The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection Yusuke Sugasawa • Keisuke Yamaguchi • Seiichiro Kumakura • Taisuke Murakami • Toyoki Kugimiya • Kenji Suzuki • Isao Nagaoka • Eiichi Inada Received: 2 November 2010 / Accepted: 18 January 2011 / Published online: 8 February 2011 Ó Japanese Society of Anesthesiologists 2011 Abstract Purpose One-lung ventilation (OLV) is commonly used during thoracic surgery. Clinical studies using bronchoal- veolar lavage fluid analysis have demonstrated that OLV induces pulmonary inflammatory reactions in the ventilated dependent lung. However, few clinical studies have investigated such inflammatory reactions in the dependent lung compared with the collapsed nondependent lung. Here we used a bronchoscopic microsampling method to obtain epithelial lining fluid (ELF) from each lung, and then compared the inflammatory reactions in the dependent lung and the nondependent lung during thoracic surgery. Methods Twenty adult patients were studied. All patients underwent thoracic surgery using OLV. Propofol and remifentanil were used for total intravenous anesthesia. A double-lumen endotracheal tube was used to perform OLV. ELF was obtained from each lung using the bron- choscopic microsampling method. ELF levels of inflam- matory mediators, tumor necrosis factor a, interleukin (IL)-1b, IL-6, IL-8, IL-10, and IL-12p70 were measured using ELISA before and after OLV. Results ELF levels of IL-1b, IL-6, and IL-8 were sig- nificantly increased in the dependent lung and the nonde- pendent lung at the end of surgery compared with their baseline levels (p \ 0.05). ELF level of IL-6 was signifi- cantly higher in the dependent lung than in the nonde- pendent lung at the end of surgery (p = 0.019). Conclusions One-lung ventilation induced inflammatory responses of the bronchial epithelia in the dependent lung and the nondependent lung during thoracic surgery. In addition, these inflammatory responses were more aug- mented in the dependent lung than in the nondependent lung. Keywords One-lung ventilation Á Epithelial lining fluid Á Bronchoscopic microsampling Á Pulmonary inflammation Á Cytokine Introduction One-lung ventilation (OLV) is commonly used in thoracic surgery. During OLV, pulmonary inflammatory reactions can be induced by multiple factors such as mechanical damage due to surgical manipulation, OLV-induced ate- lectasis and re-expansion, damage by high oxygen tension, or by high inspiratory pressure due to mechanical ventila- tion [1–5]. Some studies have shown that bronchial epithelia express various immune molecules [6, 7]. Inflammatory cytokines, tumor necrosis factor a, interleukin (IL)-1b, IL-6, and IL-8 are important chemoattractants that affect the recruitment of neutrophils and alveolar macrophages. Alveolar macrophages not only act as phagocytes but also secrete biologically active products, thereby play a Y. Sugasawa (&) Á K. Yamaguchi Á S. Kumakura Á T. Kugimiya Á E. Inada Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan e-mail: ysugasa@juntendo.ac.jp T. Murakami Á I. Nagaoka Department of Host Defense and Biochemical Research, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan K. Suzuki Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan 123 J Anesth (2011) 25:170–177 DOI 10.1007/s00540-011-1100-0