Acute lung injury after pulmonary resection surgery for lung cancer and anesthetic management

Abstract

Takeshi Suzuki, Kenta Wakaizumi, Jungo Kato, Takashige Yamada, Hiroshi Morisaki

Although the outcome of patients undergoing pulmonary resection surgeries for lung cancer has improved, postoperative acute lung injury (ALI) remains the leading cause of death. High oxygen concentration, high peak airway pressure, and hyper-perfusion due to hypoxic pulmonary vasoconstriction play a major role in the development of ALI in the ventilated dependent lung during one-lung ventilation. In the collapsed non-dependent lung, mechanical stress induced by re-expansion, ischemia-reperfusion injury, and direct surgical manipulation are associated with the onset of ALI. These contributing factors to ALI elicit local inflammatory responses, resulting in pulmonary edema that resembles acute respiratory distress syndrome histologically. Some preventive strategies to reduce ALI are recommended during mechanical ventilation, OLV support in particular. A lung protective strategy, including sufficient positive end-expiratory pressure, low tidal volume, and lower inspiratory oxygen concentration, should be adopted to attenuate lung damage. The application of continuous positive airway pressure to the collapsed non-dependent lung has been shown to reduce inflammatory cytokines. Given that excessive fluid administration is associated with the risk of postoperative pulmonary complications, a fluid restrictive strategy should be considered to prevent ALI. Anesthetic management may affect the onset of postoperative ALI. Compared to propofol anesthesia, volatile anesthetics have been shown to attenuate local inflammatory responses in both lungs during thoracic surgeries. Thoracic epidural analgesia may attenuate a local inflammatory response in the lung through the blockade of sympathetic nerve stimulation. Thus, more effective strategies to prevent ALI should be investigated to improve the prognosis of patients undergoing thoracic surgeries

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