[Changes in acid-base equilibrium, ventilation parameters and immunologic reactions in thoracoscopic operations]

In the thoracoscopic operations it is usually necessary to deflate completely the ipsilateral lung. The aim of this study was to determine changes of blood gases and alterations of immune response mediators during thoracoscopic surgery with one-lung ventilation OLV. In the study 38 patients were included undergoing thoracoscopic or video-assisted thoracic surgery. Arterial blood gases, respiratory parameters, heart rate, blood pressure were determined before one-lung ventilation, at the peak of operation and after finishing OLV. The circulatory cytokines IL-1 beta, IL-2, IL-6, IL-8, TNF-alpha, and reactive oxygen species (ROS) were measured before and after operation, 3 h, 24 h and 48 h after operation. The obtained variables were statistically evaluated. One-lung ventilation caused a significant increase of PaCO2 (from 4.69 +/- 0.67 to 5.91 +/- 0.87 kPa) which was accompanied by an adequate decrease of pH (7.455 +/- 0.033-7.368 +/- 0.037) and a number of patients developed respiratory acidosis (34%). There were no significant changes in levels of the investigated cytokines, only a mild increase of IL-6, IL-8 and TNF during first 24 h after operation was observed. The activity of ROS was highest at the end of the operation, but did not differ significantly from the start, but then decreased significantly for a period of 24 h. The authors conclude that the observed increase of carbon dioxide levels and decrease of pH had no impact on the fate of the patients. Thoracoscopic or VATS procedures were a minimal load for patients causing no significant changes of proinflammatory cytokines. The operations did not significantly elevate the activity of ROS.