Effect of prostaglandin E1 on inflammatory responses and gas exchange in patients undergoing surgery for oesophageal cancer

Background. Oesophageal surgery causes morbidity and mortality from respiratory complications. We tested the possibility that prostaglandin E-1 (PGE(1)) could reduce inflammatory cytokine responses and improve gas exchange after oesophagectomy. Methods. We randomized 14 patients into two groups. One group received PGE(1) 20 ng kg(-1) min(-1) i.v. during anaesthesia (PGE(1) group) and the other group did not (control group). Anaesthesia was maintained with sevoflurane and epidural anaesthesia. During oesophagectomy, ventilation of one lung was carried out with a double-lumen bronchial tube. The patients were extubated on or after the first postoperative day. Blood samples were taken at induction of anaesthesia, at the end of thoracotomy, at the end of the operation, 2 h after surgery and on the first day after surgery. Results. The groups were similar for ASA physical status, age, FEV1%, operation time, duration of thoracotomy, intraoperative fluid volume and blood loss. The arterial blood gas and arterial pressure during surgery were also similar in the PGE(1) and control groups. However, the Pa-o2/Fi(o2) ratio on the first day after surgery was significantly greater in the PGE(1) group compared with the control group. Serum concentrations of IL-6 and IL-8 increased after surgery in both groups. IL-6 was significantly less in the PGE(1) group at the end of the operation and 2 h after the operation. Conclusions. Intraoperative PGE(1) reduced IL-6 production in patients undergoing oesophagectomy and oxygenation was better in the postoperative period.