[Ketamine inhalation before one-lung ventilation for perioperative lung protection in thoracic surgery patients].

Objective To explore the effects of ketamine inhalation before one-lung ventilation (OLV) in patients undergoing transthoracic esophagectomy for esophageal cancer. Methods Upon the approval of hospital ethic committee,90 American Society of Anesthesiologists grade Ⅰ-Ⅱ patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly divided into 3 groups.After intravenous anesthesia with double-lumen endobronchial intubation, the patients in each group received different therapies before OLV, i.e.inhaling ketamine 1 mg/kg in Group Ki, intravenous infusion of kemamine 1 mg/kg in Group Kv and inhaling normal saline 10 ml in Group C.Arterial blood gas analysis was performed.And (oxygen saturation) SpO2, (partial pressure of end-tidal carbon dioxide) PETCO2, (airway pressure) Paw and hemodynamic indicators were recorded at these points:before OLV (T1), OLV for 30 min (T2), OLV for 1 h (T3), OLV for 2 h (T4), OLV ended 5 min (T5) and end of surgery (T6).Central venous blood was sampled at T1, T2 and 2 h after surgery (T7) for the determination of interleukin-6 (IL-6), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations by enzyme-linked immunosorbent assay (ELISA). Results Serum levels of IL-6, IL-8 and sICAM-1 in all groups increased significantly than those at previous timepoints.Serum levels of IL-6, IL-8 and sICAM-1 in Groups Ki and Kv were significantly lower than those in Group C at T7.PaO2 in Groups Ki and Kv was significantly higher than that in Group Cat T4.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Group Kv were significantly higher than that in Groups Ki and C at T2-T4; HR in Group Kv was significantly higher than that in Group C at T2-T3.Paw in Group Kv was significantly higher than that in Group Cat T2-T6. Conclusion Inhalation and intravenous infusion of ketamine before OLV are equally effective in lowering the serum levels of IL-6, IL-8 and sICAM-1.And ultrasonic atomizing inhalation of ketamine can avoid adverse effects on airway pressure and circulatory system caused by an intravenous infusion of ketamine. Key words: Ketamine; Esophageal neoplasms; Cytokines; Ultrasonic atomizing inhalation