Schematic illustration of proposed bactericidal property and improvement of lung injury of sevoflurane combined oxygen. In sepsis, sevoflurane (0.5 MAC) combined with 60% oxygen increases NO production promoting neutrophils and macrophages implement bactericidal property, and thus reducing the abdominal and systemic inflammatory responses; also sevoflurane (0.5 MAC) combined with 60% oxygen increases NO production reducing neutrophils infiltration into lung and thus improving lung injury. The reduction of inflammatory response and lung injury improve the survival rate of sepsis.

Volatile anesthetics have been proven to treat experimental sepsis. Sevoflurane combined with oxygen is widely applied in the clinic, and our previous study indicated that this regimen significantly reduced sepsis-induced inflammatory responses and that inhibition of NF-κB pathway activation may contribute to this protection effect. Furthermore, our previous data has shown that sevoflurane combined with oxygen has prevention effect on sepsis-induced lung injury properties and bactericidal properties, but the mechanism is not well understood. Nitric oxide (NO) has been shown to have bactericidal effects and mitigating effects on lung injury, but this is not well studied in sepsis. The present study suggested that in cecal ligation and puncture (CLP)-induced sepsis, sevoflurane combined with oxygen had bactericidal effects and reduced neutrophil infiltration into the lung, preventing inflammatory lung injury. NO production was significantly induced in peritoneal lavage fluid and bronchoalveolar lavage fluid. These effects were abolished by pharmacological inhibition of nitric oxide synthase activity. Thus, our findings suggest that sevoflurane combined with oxygen exerts bactericidal effects and prevents lung injury in sepsis through the NO pathway.