الفهرس 
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Abstract
Thoracic anaesthesia includes a wide variety of diagnostic and therapeutic procedures involving the lungs, airways and other intrathoracic structures. Fundamental to anaesthetic management for the majority of thoracic procedures is lung isolation to facilitate surgical access within the thorax and management of one-lung anaesthesia. One lung ventilation is a technique that allows isolation of the individual lungs under anaesthesia.
The stress response to surgery is the name given to the hormonal and metabolic changes following injury or trauma. It is a major neuroendocrine and cytokine response to surgical trauma. A suppressed inflammatory response or prolonged illness may result in compromised organ function that requires exogenous support.
The aim of this work was to compare between the effects of propofol and sevoflurane as regards the systemic inflammatory response (IL-6 and TNF-α) through serum analysis, the pulmonary inflammatory response (IL-6 and TNF-α) through BAL analysis,C-reactive protein and leukocyte count in serum. Also to compare between both groups as regarding recovery status.
After approval of the Ethical Committee of the Faculty of Medicine and an informed written consent from each patient was obtained, a prospective randomized blind study was performed. This study was carried out on 40 adult patients, of both sex, admitted to Alexandria Main University Hospital, Department of Cardiothoracic Surgery. Patients were scheduled for elective lung resection surgery through thoracotomy using OLV technique.
Patients were randomly classified into two equal groups twenty patients each using closed envelope technique according to the drug used for maintenance of anaesthesia intraoperatively .Group I (Propofol group) patients received total intravenous anaesthesia with propofol and group II (Sevoflurane group) patients received inhalational anaesthesia with sevoflurane.
Measurements
Following data were recorded for all patients in both groups:
● Demographic data.
● Type of surgery (lobectomy, segmentectomy and lung biopsy).
● Haemodynamic parameters including:
A- Heart rate.
B- Mean arterial blood pressure.
Parameters were recorded at the following times; base line value (before induction), just after intubation, with skin incision , every 15 minutes during surgery, before one lung ventilation and 15 minutes after one lung ventilation ended.
● Arterial blood gases analysis (before OLV and 15 minutes after OLV ended and resumption of double lung ventilation).
● BAL and serum analysis for IL-6 and TNF-α .Both were measured before OLV and 15 minutes after OLV ended.
● C-reactive protein and leukocyte count. (before OLV and 15 minutes after OLV).
● Duration of anaesthesia, surgery and OLV
● Recovery status. A score for consciousness, airway and motor activity. The score was recorded on admission to the recovery room and 15 minutes after that.
The results of the present study showed that:
There was no statistically significant difference between both groups as regarding:
● Demographic data.
● Type of operation .
● Haemodynamic parameters including heart rate and mean arterial blood pressure.
● Duration of anaesthesia, surgery and OLV.
In the present study, there was no significant difference between both groups as regarding ABG analysis before and after OLV, however there was significant decrease in PaO2 in both groups after OLV in relation to before OLV.
According to IL-6 and TNF-α, there was no statistically significant difference between the two groups before OLV, however they were significantly increased in both groups in serum and BAL after OLV in relation to before OLV with significant increase in propofol group relative to sevoflurane group. A significant correlation was present between increased level of IL-6 and TNF-α in BAL and their levels in serum after OLV in the sevoflurane group but this correlation was not present in the propofol group. Also no significant correlation between duration of OLV and inflammatory mediators (IL-6 and TNF-α) in serum and BAL in both groups.
As regarding to CRP, there was no statistically significant difference between the two groups before OLV. After OLV and on the 2nd postoperative day the level of CRP increased significantly in both groups with significant increase in propofol group relative to sevoflurane group.
According to WBC count there was no statistically significant difference between the two groups as regards the level of WBC before OLV. After OLV the level of WBC increased significantly in propofol group only. On the 2nd postoperative day the level of WBC increased significantly in both groups with significant increase in propofol group relative to sevoflurane group. Also no significant correlation between duration of OLV with the increased levels of CRP and WBC count in both groups.
There was no statistically significant difference between both groups as regards recovery score on admission to the recovery room and 15 minutes after that with significant increase in total score 15 minutes after admission to recovery room in both groups.