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CRITICAL CARE AND TRAUMA

The Effects of Fenoterol Inhalation After Acid Aspiration-Induced Lung Injury

Michael T. Pawlik, MD^*, Thomas Schubert, MD, Susanne Hopf, MD^*, Matthias Lubnow, MD, Michael Gruber, PhD^*, Christoph Selig, MD, Kai Taeger, MD, PhD^*, and Karl P. Ittner, MD^*

From the Departments of *Anesthesiology, Pathology, Cardiology, Pulmonology and Intensive Care, University Hospital, Regensburg, Germany; and Department of Anesthesiology, University Hospital Ulm, Ulm, Germany.

Address correspondence and reprint requests to Michael Pawlik, MD, DEAA, Department of Anesthesiology, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany. Address e-mail to michael.pawlik{at}klinik.uni-regensburg.de.

BACKGROUND: Acid aspiration is a serious complication that can occur during general anesthesia. Studies show that β-agonists have beneficial effects on lung injury. Therefore, we tested the effect of the nebulized β-agonist fenoterol on lung variables in a rodent model of acid-induced lung injury.

METHODS: In a prospective, randomized, and controlled study, we evaluated the effects of fenoterol inhalation on lung oxygenation, inflammation, and pulmonary histology in a rat model of acid-induced lung injury. Sprague-Dawley rats underwent sevoflurane anesthesia with tracheotomy and carotid catheter insertion. Lung injury was induced by instillation of 0.4 mL/kg 0.1 M hydrochloric acid. The lungs were ventilated for 6 h and randomized to receive either fenoterol inhalation 10 µg or saline inhalation, both at 15 and 180 min after acid aspiration. Mean arterial blood pressures and peak airway pressures were documented, arterial blood gases were determined at 30, 90, 180, 270, and 360 min, and postmortem histology was subsequently examined. Additionally, fenoterol concentrations in bronchoalveolar lavage fluid (BALF) and plasma were determined by liquid chromatography/tandem mass spectroscopy. After 360 min tumor necrosis factor (TNF)- and interleukin (IL)-6 were determined in the BALF, and lungs were dried for determination of the wet/dry ratio.

RESULTS: Inhalation treatment with 10 µg fenoterol significantly increased oxygenation after 270 and 360 min when compared with placebo. Fenoterol-treated rats showed a significant decrease in IL-6 and TNF- levels and in the wet/dry weight ratio of the lungs. The histologic appearance showed significantly less interstitial edema and leukocyte infiltration in the fenoterol group. The concentration of fenoterol was 10.3 µg/L (median) in the BALF and <1 µg/L in the plasma.

CONCLUSIONS: Fenoterol inhalation improved oxygenation after 270 and 360 min, attenuated the release of TNF- and IL-6, and diminished the lung edema and infiltration of polymorphonuclear leukocytes.