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Eur J Cardiothorac Surg 2006;30:412-413
© 2006 Elsevier Science NL

Letter to the Editor

Oxidative stress and one-lung ventilation

Division of Thoracic Surgery, Department of Surgery, The Western Pennsylvania Hospital, 4815 Liberty Ave, Ste 158, Pittsburgh, PA 15224, United States

Received 28 March 2006; accepted 1 May 2006.

^_* Tel.: +1 412 578 3505. (Email: tbirdas1{at}aol.com).

Key Words: Lung—basic science • Anesthesia

I read with great interest the paper by Misthos et al. [1]. In this prospective, nonrandomized report, the authors examine the effects of the duration of one-lung ventilation (OLV) on the levels of malondialdehyde (MDA), a surrogate for oxidative stress. MDA levels were significantly higher in patients with prolonged OLV, with complications such as cardiac arrhythmias, acute respiratory failure, and pulmonary hypertension occurring more commonly in patients with OLV for 120 min.

While the findings are indeed very interesting, some methodology-related questions are raised. It might be more accurate to use OLV duration as a continuous variable in the statistical analysis instead of arbitrarily selecting grouping values. It is also unclear if these groups are inclusive of intermediate values (i.e., 0–60 min, 60–90 min, etc.). The authors did not specify the time of occurrence of reported complications, particularly cardiac arrhythmias. It might be difficult to prove causation between a short-lived (<6 h) stress response and an event that is typically seen 2–3 days later. In addition, important confounding factors, such as use of epidural anesthesia, perioperative hypotensive events, pharmacologic antiarryhtmic prophylaxis, and blood product transfusion, are not addressed.

Reperfusion injury following lung re-expansion is an emerging pathophysiologic mechanism and the authors’ report is a useful addition to the literature. It may be difficult, however, to reach specific conclusions as to the duration of safe OLV based on the presented data.

References

1. Misthos P, Katsaragakis S, Theodorou D, Milingos N, Skottis I. The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study. Eur J Cardiothorac Surg 2006;29:591-595.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas J. Birdas Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Birdas, T. J. Search for Related Content PubMed PubMed Citation Articles by Birdas, T. J. Related Collections Anesthesia Lung - basic science