Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 5, August, p. 817–823

doi: 10.17219/acem/61045

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

The effect of desflurane and propofol protocols on preconditioning

Didem Onk1,A,B,D, Fatih Ozcelik2,D, Ufuk Kuyrukluyıldız1,B, Murat Gunay3,B,C, Alper Onk4,B, Tulin Akarsu Ayazoglu5,A, Abdulkadir Coban3,E,F, Aysin Alagol1,E,F

1 Anesthesiology Department, Erzincan University, Erzincan, Turkey

2 Clinical Biochemistry Laboratory, Erzincan Military Hospital, Erzincan, Turkey

3 Biochemistry Department, Erzincan University, Erzincan, Turkey

4 Cardiovascular Surgery Department, Erzincan University, Erzincan, Turkey

5 Clinical Anesthesiology, Goztepe Training and Research Hospital, Istanbul, Turkey

Abstract

Background. Preconditioning is one of the most powerful mechanisms preventing the myocardial ischemic damage that occurs during coronary artery bypass grafting.
Objectives. We aimed to investigate the effects of different propofol and/or desflurane administration protocols in terms of the prevention of ischaemia-reperfusion damage.
Material and Methods. Ninety patients, aged > 18 years, American Society of Anesthesiologists (ASA) category III, scheduled to undergo primary elective coronary artery bypass grafting (CABG), were included in the study. During maintenance, the patients in group 1 (n = 30) received a propofol infusion (5–6 mg/kg/h) combined with a fentanyl infusion (3–5 mcg/kg/h); the patients in group 2 (n = 30) also received a propofol infusion (5–6 mg/kg/h) combined with a fentanyl infusion (3–5 mcg/kg/h), but they were also given 6% desflurane inhalation for 15 min both before cross-clamping of the aorta and after removal of the clamp; the patients in group 3 (n = 30) received a propofol infusion (2–3 mg/kg/h) combined with a fentanyl infusion (3–5 mcg/kg/h) and received the continuous 6% desflurane inhalation. Blood samples were drawn in the preoperative period (S1), during cardiopulmonary bypass, before cross-clamping the aorta (S2), after removal of the cross-clamp (S3) and 24 h after the operation (S4).
Results. All groups were similar in terms of age and BMI (p > 0.05). TNF-α levels were higher at S3 compared to S1, S2 and S4 (p > 0.001). The TNF-α levels at S4 were lower in group 3 than those in group 1 and group 2 (p < 0.05). In all groups, h-FABP levels showed an increase in S3 but were significantly lower at S4 (p < 0.05). In group 3, h-FABP levels at S2 and S3 were significantly lower than those in group 1 (p < 0.05). There was a moderate correlation between h-FABP and TNF-α levels (Spearman’s rho = 0.472, p < 0.001).
Conclusion. On the basis of the measurement of h-FABP and TNF-α, low-dose propofol and continuous desflurane inhalation provide more effective preconditioning than propofol alone or a short course of desflurane in patients undergoing CABG.

Key words

preconditioning, propofol, desflurane

References (24)

  1. Banerjee A, Locke-Winter C, Rogers KB, et al. Preconditioning against myocardial dysfunction after ischemia and reperfusion by an alpha-1 adrenergic mechanism. Circ Res. 1993;73:656–670.
  2. Ghosh S, Standen NB, Galiñanes M. Evidence for mitochondrial KATP channels as effectors of human myocardial preconditioning. Cardiovasc Res. 2000;45:934–940.
  3. Raphael J, Zuo Z, Abedat S, Beeri R, Gozal Y. Isoflurane preconditioning decreases myocardial infarction in rabbits via up-regulation of hypoxia inducible factor 1 that is mediated by mammalian target of rapamycin. Anesthesiology. 2008;108(3):415–425.
  4. Murphy PG, Myers DS, Davies, MJ, Webster NR, Jones JG. The antioxidant potential of propofol (2,6-diisopropylphenol). Br J Anaesth. 1992;68:613–618.
  5. Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery. A meta-analysis. Br J Anaesth. 2006;97:127–136.
  6. Ansley DM, Xia Z, Dhaliwal BS. The relationship between plasma free 15-F2t-isoprostane concentration and early postoperative cardiac depression following warm heart surgery. J Thorac Cardiovasc Surg. 2003;126:1222–1223.
  7. Hall RI. Identification of inflammatory mediators and their modulation by strategies for the management of the systemic inflammatory response during cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2013;27:983–1033.
  8. Huang Z, Zhong X, Irwin MG, et al. Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients. Clin Sci. 2011;121:57–69.
  9. Petzold T, Feindt P, Sunderdiek U, Boeken U, Fischer Y, Gams E. Heart-type fatty acid binding protein (hFABP) in the diagnosis of myocardial damage in coronary artery bypass grafting. Eur J Cardiothorac Surg. 2001;19:859–864.
  10. Borgermann J, Friedrich I, Floh´e S, et al. Tumor necrosis factor-α production in whole blood after cardiopulmonary bypass: Downregulation caused by circulating cytokine-inhibitory activities. J Thorac Cardiovasc Surg. 2002;124:608–617.
  11. Sumitomo M, Tachibana M, Nakashima J, et al. An essential role for nuclear factor kappa B in preventing TNF-alpha-induced cell death in prostate cancer cells. J Urol. 1999;161(2):674–679.
  12. Ko SH, Yu CW, Lee SK, et al. Propofol attenuates ischemia-reperfusion injury in the isolated rat heart. Anest Analg. 1997;85:719–724.
  13. Laffey JG, Boylan JF, Cheng CH. The systemic inflammatory response to cardiac surgery. Anesthesiology. 2002;97:215–252.
  14. Engels M, Bilgic E, Pinto A, et al. A cardiopulmonary bypass with deep hypothermic circulatory arrest rat model for the investigation of the systemic inflammation response and induced organ damage. Journal of Inflammation. 2014;11:26.
  15. Konstantinov IE, Arab S, Kharbanda RK, et al. The remote ischemic preconditioning stimulus modifies inflammatory gene expression in humans. Physiol Genomics. 2004;19(1):143–150.
  16. Landoni G, Biondi-Zoccai GG, Zangrillo A, et al. Desflurane and sevoflurane in cardiac surgery: A meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth. 2007;21(4):502–511.
  17. Jakobsen CJ, Berg H, Hindsholm KB, Faddy N, Sloth E. The influence of propofol versus sevoflurane anesthesia on outcome in 10,535 cardiac surgical procedures. J Cardiothorac Vasc Anesth. 2007;21:664–671.
  18. Smul TM, Stumpner J, Blomeyer C, et al. Propofol inhibits desflurane-induced preconditioning in rabbits. J Cardiothorac Vasc Anesth. 2011;25(2):276–281.
  19. De Hert SG, Van der Linden PJ, Cromheecke S, et al. Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass. Anesthesiology. 2004;101:9–20.
  20. Sayın MM, Özatamer O, Taşöz R, Kilinç K, Ünal N. Propofol attenuates myocardial lipid peroxidation during coronary artery bypass grafting surgery. Br J Anaesth. 2002;89:242–246.
  21. Kilcullen N, Viswanathan K, Das R, et al. Heart-type fatty acid-binding protein predicts long-term mortality after acute coronary syndrome and identifies high-risk patients across the range of troponin values. J Am Coll Cardiol. 2007;50:2061–2067.
  22. Tomai F, De Paulis R, Penta de Peppo A, et al. Beneficial impact of isoflurane during coronary bypass surgery on troponin I release. G Ital Cardiol. 1999;29:1007–1014.
  23. Zhang JQ, Wang Q, Xue FS, et al. Ischemic preconditioning produces more powerful anti-inflammatory and cardioprotective effects than limb remote ischemic postconditioning in rats with myocardial ischemia-reperfusion injury. Chin Med J (Engl). 2013;126(20):3949–3955.
  24. Zhang SH, Wang SY, Yao SL. Antioxidative effect of propofol during cardiopulmonary bypass in adults. Acta Pharmacol Sin. 2004;25:334–340.