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Pulmonary microvascular injury following general anaesthesia with volatile anaesthetics--halothane and isoflurane: a
B Gunaydin1, Y Karadenizli, A Babacan
1Department of Anaesthesiology, Gazi University, Faculty of Medicine, Ankara, Turkey.
Abstract:
Pulmonary microvascular injury has become a recently studied phenomenon that may be responsible for most of the complications associated with the lungs. Thirty patients undergoing partial hemilaminectomy or discectomy due to hernia of nucleus pulposus underwent Tc-99m HMPAO lung clearance as well as Tc-99m pertechnetate lung scintigraphy pre-operatively, and following general anaesthesia with halothane and isoflurane (third, fourth and tenth post-operative days). The results were compared with conventional techniques and haemodynamic parameters during the peri-operative period. In order to demonstrate acute phase changes under general anaesthesia and to perform pathological examinations, 21 New Zealand rabbits underwent radionuclide studies with Tc-99m HMPAO or Tc-99m pertechnetate. Lung biopsies were also performed. Despite no significant differences in any of the conventional diagnostic techniques, Tc-99m pertechnetate lung scintigraphy was performed for both the halothane and isoflurane groups, and Tc-99m HMPAO lung clearance was performed for the isoflurane group pre- or post-operatively. Tc-99m HMPAO lung clearance was impaired significantly in the halothane group on the third post-operative day (half time: 6.4 +/- 1.6 pre-operative and 13.76 +/- 3.3 s, P < 0.001) decreasing to pre-operative levels on the tenth post-operative day. Acute phase exposure to halothane was characterized with extremely abnormal Tc-99m HMPAO lung clearance in rabbits with respect to isoflurane, diminishing to control levels on the third day (half time: 8.7 +/- 86 control and 28.65 +/- 4.6, P < 0.001). Pathological examinations also demonstrated endothelial damage on acute exposure in the halothane group. General anaesthesia with halothane may give rise to alveolar microvascular injury, which generally seems to be underdiagnosed and may lead to serious post-operative complications.
Insights
General anesthesia with halothane may cause pulmonary microvascular injury, leading to lung complications. This study used radionuclide imaging to detect early lung damage from halothane versus isoflurane anesthesia.
Area of Science:
- Anesthesiology
- Pulmonary Medicine
- Nuclear Medicine
Background:
- Pulmonary microvascular injury is a potential cause of lung complications.
- General anesthesia may affect lung microvasculature.
Purpose of the Study:
- To investigate the effects of halothane and isoflurane anesthesia on pulmonary microvascular function.
- To assess the utility of radionuclide imaging in detecting anesthesia-induced lung injury.
Main Methods:
- Tc-99m HMPAO lung clearance and Tc-99m pertechnetate lung scintigraphy were performed on 30 patients and 21 rabbits.
- Patients underwent procedures under halothane or isoflurane anesthesia.
- Animal models were used to examine acute effects and pathological changes, including lung biopsies.
Main Results:
- Halothane anesthesia significantly impaired Tc-99m HMPAO lung clearance in patients and rabbits.
- Impaired lung clearance returned to baseline by the tenth post-operative day.
- Pathological examinations revealed endothelial damage in rabbits exposed to halothane.
Conclusions:
- General anesthesia with halothane can induce pulmonary alveolar microvascular injury.
- This injury may be underdiagnosed and contribute to post-operative pulmonary complications.
- Radionuclide imaging can detect early signs of anesthesia-related lung microvascular dysfunction.