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Ann Thorac Surg 1996;61:955
© 1996 The Society of Thoracic Surgeons
DR IRVING L. KRON (Charlottesville, VA): Doctor Schmid, I have two questions for you. Question one is: If you added the 2 animals whose lidocaine levels were not therapeutic, would that have changed your results?
And the second question is: Have you in this model used any other form of neutrophil inhibition and did you get similar results? I know your group has done a great deal of work in this area.
DR SCHMID: I will answer the second question first: This canine model has been used in our laboratory for several years. One of the studies evaluating the effect of pentoxifylline will be presented later this morning. Pentoxifylline is also an inhibitor of neutrophil adherence, and we observed similar results.
To answer the first question, the oxygen tension in the animals with low lidocaine levels was similar to that in the control animals. It was one of the problems in this experiment that we observed a quite large interindividual difference in serum lidocaine levels. We could not assess the levels during the experiment and adjust the dose because it takes too long in the laboratory to measure the lidocaine levels.
DR DANIEL L. MILLER (Louisville, KY): I have two questions for you. First of all, do you have any experience with desferrioxamine as an agent to reduce reperfusion injury after lung transplantation? We currently flush the allograft with desferrioxamine before completing the pulmonary artery anastomosis. Second, I was surprised by the extremely low oxygenation levels in your control animals, and I wonder if you could tell us the reason for the low levels.
DR SCHMID: To induce a very severe reperfusion injury we preserved the lungs for 24 hours. Additionally we occluded the contralateral pulmonary artery and therefore the whole cardiac output was directed to the transplanted lung. For these conditions I think the oxygen tension levels in the controls are very reasonable. Can you please repeat the first question?
DR MILLER: Yes. We use the iron chelator desferrioxamine to help reduce reperfusion injury after lung transplantation. Before completion of the pulmonary artery anastomosis, we flush the transplanted lung with a normothermic leukocyte-poor solution composed of the patient's blood and desferrioxamine. In our limited experience, we have found a significant reduction of reperfusion injury after single-lung transplantation.
DR SCHMID: At the time of harvest we flushed the lungs with lidocaine as an additive. In the recipient I had to start the lidocaine infusion very early during the operation. When I gave a lidocaine bolus just before reperfusion the ligation of the contralateral pulmonary artery was poorly tolerated. When I ligated the right pulmonary artery after achieving a stable lidocaine level we avoided this problem of severe hypotension after contralateral pulmonary artery occlusion.
Related Article
Ann. Thorac. Surg. 1996 61: 949-955.
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