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IMMUNOHISTOCHEMICAL CHANGES IN THE LUNGS AFTER LOCAL
AND GENERAL ANESTHESIA IN EXPERIMENTAL MECHANICAL
TRAUMA
Ganiev Shavkat Sulaymonovich
Bukhara State Medical Institute
https://doi.org/10.5281/zenodo.13336074
Many authors have assessed the effective action of isoflurane using an
ischemic pulmonary model with ex vivo reperfusion [13]. Based on these
actions, researchers have concluded that when preliminary preconditioning
with isoflurane occurs, vascular resistance indicators increase and pulmonary
tissue edema. The authors performed a comparative assessment of sevoflurane
and isoflurane in terms of their effect on reducing ischemic and reperfusion
injury to lung tissue, and found that a single inhalation at a minimum alveolar
concentration 30 minutes before ischemic reperfusion with any anesthetic
resulted in a decrease in lung injury biomarkers in an ex vivo model [13–15].
The authors took into account existing studies on the effects of
anesthetics on organs, primarily the heart, and proposed a number of
hypothesis-based mechanisms of action, such as decreased secretion of tumor
necrosis factor alpha (TNF-alpha), decreased adhesion and migration of
neutrophils, decreased levels of free oxygen radicals, and decreased metabolic
rate [16]. Preconditioning with isoflurane resulted in a decrease in the level of
lung tissue damage using lipopolysaccharide in the form of a sol; the study was
conducted on mice [16, 17, 23]. This model of early preconditioning,
administered 60 min before lung injury, is associated with a reduction in
concentrated chemotactic chemokines, but the question remains whether this is
a drug effect or a protective mechanism.
Another study showed that preconditioning with isoflurane or
sevoflurane resulted in an increase in survival in sepsis-induced lung injury in
rats [18, 23]. The protective mechanism remains unclear, despite the reduction
in oxidation markers and the solubility of ICAM-1 levels with sevoflurane. The
protective function provided by sevoflurane has been demonstrated in a pig
autotransplanted lung model with reduced levels of TNF-alpha, interleukin-1
(IL-1), lipid peroxide, and nitric oxide (NO) [19, 21, 22].
Clinical studies report that preconditioning with sevoflurane reduces lung
tissue edema and increases pulmonary vein PO2 values with reimplantation of
the lobes. It should be noted that oxygenation improved only briefly ten minutes
after reimplantation, and returned to baseline values within half an hour.
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Despite the short-term effect of sevoflurane during preconditioning, the results
obtained are encouraging. The question of how this benefit for lung function can
be translated into practical clinical practice is unclear [19–21]. The data
obtained allow us to conclude that the issue of lung preconditioning during
anesthesia remains open and unresolved. The experimental studies have
demonstrated the protective mechanism during preconditioning, but it is
difficult to apply these findings in clinical settings. To date, five clinical studies
have been conducted on preconditioning of the patient's lungs during anesthesia
[17–21], of which only one demonstrates an advantage in using remote ischemic
preconditioning of the lung tissue [21]. Clinical studies devoted to the use of
pharmacological drugs in this area are also currently lacking.
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