Effect of penehyclidine hydrochloride on damage to non-ventilated lung in pediatric patients undergoing one-lung ventilation

Objective To evaluate the effect of penehyclidine hydrochloride on the damage to the non-ventilated lung in the pediatric patients undergoing one-lung ventilation(OLV). Methods One hundred and twenty pediatric patients of both sexes, aged 2-6 yr, with body mass index of 17-24 kg/m2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ and New York Heart Association classⅠ or Ⅱ, undergoing elective lobectomy performed via video-assisted thoracoscope, were randomly divided into 2 groups(n=60 each)using a random number table: control group(group C)and penehyclidine hydrochloride group(group P). At 10 min before anesthesia induction, penehyclidine hydrochloride 0.05 mg/kg was injected intravenously in group P, and the equal volume of normal saline was given in group C. At 5 min after drug intervention(T0), immediately after onset of OLV(T1), at 60 min of OLV(T2), immediately after the end of OLV(T3), at the end of surgery(T4), and at 24 h after surgery(T5), venous blood samples were collected for determination of serum tumor necrosis factor-alpha(TNF-α), interleukin-6(IL-6)and IL-8 concentrations by enzyme-linked immunosorbent assay.The specimens of normal lung tissues around the lung lobe to be resected were obtained at T1 and T3 for determination of the injured alveolus count(with a light microscope)and cell apoptosis(using TUNEL)and for examination of the ultrastructure of epithelial cells(with a transmission electron microscope). The injured alveolus rate(IAR)and apoptosis index(AI)were calculated. Results Compared to the value at T0, the IAR and AI were significantly increased at T3, the serum TNF-α, IL-6 and IL-8 concentrations were significantly increased at T2-5(P<0.05), and the pathological changes were obvious in the two groups.Compared to group C, the IAR and AI were significantly decreased at T3, the serum TNF-α, IL-6 and IL-8 concentrations were significantly decreased at T2-5(P<0.05), and the pathological changes were significantly reduced in group P. Conclusion Penehyclidine hydrochloride can attenuate the damage to the non-ventilated lung in the pediatric patients undergoing OLV, and the mechanism is probably related to inhibition of systemic inflammatory responses and cell apoptosis in lung tissues. Key words: Cholinergic antagonists; Respiration artificial; Reperfusion injury; Lung