Effects Of Propofol And Sevofurane On Serum Cytokines In Children With Community-acquired Pneumonia Undergoing Flexible Fibreoptic Bronchoscopy

Community-acquired pneumonia is a common and serious illness in children.The host’s inflammatory response to microorganisms involved in pneumonia is associated with the release of pro-inflammatory and anti-inflammatory cytokines.However,excessive cytokine production can cause deleterious effects.The severity of pneumonia can be both reflected and predicted by higher levels of cytokines in the blood.Flexible fibreoptic bronchoscopy(FFB)has diagnostic and therapeutic effects on community-acquired pneumonia.As an invasive procedure,bronchoscopy can irritate the airway mucosa,and then induce the stress responses and changes in cytokines levels.General anesthetics have immunomodulatory properties.To the best of our knowledge,there has been little work focusing on the relationship between these two anesthetics and cytokine release in children with community-acquired pneumonia.The aim of this randomized controlled trail was to examine the effects of two general anesthetics on the stress hormones,serum cytokines and clinical efficacies in children with community-acquired pneumonia undergoing FFB.Part oneEffects of propofol and sevofurane on stress responses in children with community-acquired pneumonia undergoing flexible fibreoptic bronchoscopyObjective To investigate the effects of propofol and sevofurane on stress responses in children with community-acquired pneumonia undergoing FFB.Method Fifty ASA Ⅱ or Ⅲ children with community-acquired pneumonia were randomly divided into group P(propofol group)and group S(sevoflurane group),n=25 in each group.Anesthesia was induced and maintained with propofol and remifentanil in group P and with sevoflurane plus remifentanil in group S.Peripheral venous blood samples were taken at:10 min before general anesthesia induction(To),10 min after commencing of bronchoscopy(T1)and 4 h following bronchoscopy(T2)for determination of the stress hormone responses by enzyme-linked immunosorbent assay.Results There were no significant differences in demographic data and duration of bronchoscopy in both groups(P>0.05).Heart rate and mean arterial pressure decreased in both groups at 10 min after commencing of bronchoscopy compared with To(P<0.05),and there were no significant between-group differences in these parameters at T0,Ti and T2(P>0.05).Serum noradrenaline,adrenaline and cortisol decreased at 10 min after commencing of bronchoscopy(T1)and 4 h after bronchoscopy(T2)versus To,and there were no significant between-group differences at the three time points.Conclusions There were no significant differences in the effects of propofol or sevoflurane on stress responses in children with community-acquired pneumonia undergoing FFB.Part twoEffects of propofol and sevofurane on cytokines and clinical efficacies in children with community-acquired pneumonia undergoing flexible fibreoptic bronchoscopyObjective To investigate the effects of propofol and sevofurane on cytokines in children with community-acquired pneumonia undergoing FFB.Method Fifty ASA II or III children with community-acquired pneumonia were randomly divided into group P and group S,n=25 in each group.Anesthesia was induced and maintained with propofol and remifentanil in group P and with sevoflurane plus remifentanil in group S.Peripheral venous blood samples were taken at:10 min before general anesthesia induction(T0),10 min after commencing of bronchoscopy(T1),4 h following bronchoscopy(T2),1 d following bronchoscopy(T3),4 d following bronchoscopy(T4)and 7 d following bronchoscopy(T5).Serum IL-6,IL-10 and TNF-a were determined by enzyme-linked immunosorbent assay.Clinical efficacies were determined.Results There were no significant differences in demographic data and duration of bronchoscopy in both groups(P>0.05).Circulating IL-6 and IL-10 levels decreased significantly after the FFB procedure in both groups.IL-6 levels were lower in group S than group P at 4 h and 1 day after bronchoscopy(61.3±11.9 VS 82.6±19.7 pg/ml,52.8±9.7 VS 75.4±13.6 pg/ml,P<0.05).Serum TNF-a was also decreased at 4 d and 7 d after the bronchoscopy procedure,and there was no significant difference in TNF-a at any time point.The cough disappearance time in group S was shorter than group P.There was no significant difference in average temperature recovery time,fading time of crackles,recovery of lung X-ray and hospitalization days between the two groups.Conclusions In children with community-acquired pneumonia,use of sevoflurane was associated with lower serum IL-6 and IL-10 levels,and also shorter cough disappearance time compared with propofol.Pneumonia severity is reflected by higher blood cytokine levels,thus,sevoflurane may be more beneficial to recovery from community-acquired pneumonia.