A comparison of the effects of fentanyl and propofol on left ventricular contractility during myocardial stunning

Purpose: A laboratory investigation was undertaken to assess the effects of propofol on renal function, through modulation of the systemic inflammatory response, in an in vivo experimental model of aortic surgery in comparison with sevoflurane.Methods: Twenty young male piglets were anesthetized with either propofol 4 mg·kg -1 ·hr -1 (n = 10) or sevoflurane 1.5% end-tidal concentration (n = 10). Animals were subjected to aorta-aortic bypass with suprarenal aortic clamping for 30 min. At specific intervals (basal -before the start of surgery; reperfusion 15 min after unclamping the aorta; at 24, 48 and 72 hr after surgery, and on the seventh day after surgery) the levels of the following were determined: plasma creatinine, renal myeloperoxidase, tumour necrosis factor-α, interleukin 1-ß, and interferon-γ; kidney superoxide anion and its detoxifying enzyme superoxidase dismutase, kidney malondialdehyde and the activity of inducible nitric oxide synthase. Seven days after surgery, the animals were anesthetized using the described techniques, and after blood withdrawal and kidney sampling they were sacrificed. Results:In comparison with sevoflurane, propofol was associated with a lower concentration of plasma creatinine (P < 0.05) together with lower concentrations of myeloperoxidase, tumour necrosis factor-α, interleukin 1-ß, interferon-γ, superoxide anion and superoxidase dismutase, malondialdehyde and inducible nitric oxide synthase (P < 0.05). Conclusion:In an experimental model of aortic reconstructive surgery, and compared with sevoflurane, propofol anesthesia is associated with less neutrophil infiltration, lower plasma proinflammatory cytokine levels, lower production of oxygen free radicals, less lipid peroxidation, and reduced inducible nitric oxide synthase activity. These observations suggest a possible renal protective effect of propofol in this surgical setting. Objectif

Section: Discussionmentioning

confidence: 99%

Laboratory investigation: Effects of propofol on the systemic inflammatory response during aortic surgery

Rodríguez-López

Conde

Lozano

et al. 2006

“…15,18 Also, these propofol studies involved induction and/or general anesthesia with different anesthetics, followed by a bolus or infusion of propofol at some specific limited time-point. 13,[15][16][17][18][19] This leads to further confounding variables within the studies as the two different anesthetics are now integrated, making it extremely difficult to interpret the effects of propofol alone.…”

Section: Infarct Ratiomentioning

confidence: 99%

“…16 Although some have shown propofol to improve contractility following reperfusion, [13][14][15][16][17] others have shown no effects. 18,19 Reduction of myocardial necrosis by propo-982 CANADIAN JOURNAL OF ANESTHESIA FIGURE Ejection fraction (EF; mean ± SEM) normalized by the baseline (B) for both groups at each time-point (O = occlusion; R = reperfusion; D3 = day three follow-up; D10 = day ten followup). Significance * was determined for P < 0.05 between groups, as determined by single factor ANOVA.…”

Section: Infarct Ratiomentioning

confidence: 99%

“…11,12 Propofol, an alternative to isoflurane, is a widely used anesthetic that has also been inconsistently reported to offer protective effects against reperfusion injury. [13][14][15][16][17][18][19] The primary mechanism of the cardioprotection associated with isoflurane is thought to be through the activation of adenosine triphosphate (ATP)-sensitive potassium (K ATP ) channels. 2,6,7 This, along with other potential mechanisms, has been studied in a variety of ischemia/reperfusion models; with evidence for the following clinically important endpoints: reduction in infarct volume; 1-3,7-10 improved functional recovery; 4,5 and preservation of ATP.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Similar long-term cardiovascular effects of propofol or isoflurane anesthesia during ischemia/ reperfusion in dogs

Thompson

Wisenberg

Sykes

et al. 2002

P Pu ur rp po os se e: : To compare the long-term functional and metabolic effects of propofol or isoflurane general anesthesia in a canine model of ischemia/reperfusion. M Me et th ho od ds s: :Using magnetic resonance (MR) techniques, we monitored both regional metabolism ( 31 P MR spectroscopy) and systolic function of the heart ( 1 H MR imaging) throughout a two-hour occlusion of the left anterior descending coronary artery and ten days of reperfusion. Twenty-two beagles were randomized into isoflurane and propofol general anesthesia groups (n = 10, n = 12 respectively). Contrast-enhanced MR imaging was used to measure infarct size (% of left ventricle that was necrotic) and coronary blood flow was determined using radioactively labelled microspheres.R Re es su ul lt ts s: : Cardiac metabolism, as monitored by intracellular pH and high-energy phosphate ratios, was not significantly different between the two groups throughout the protocol. Relative to propofol, isoflurane reduced the depression of left ventricular ejection fraction (EF) during the ischemic period [isoflurane 68.5% ± 4.2%, propofol 58.3% ± 2.0% of baseline (B); P = 0.04], propofol increased the recovery of EF at day three (isoflurane 63.9% ± 4.3%, propofol 74.0% ± 2.5% of B; P = 0.05). By day ten, EF in both groups was similar. Infarct sizes were also similar at day ten (isoflurane 15.7% ± 3.0%, propofol 13.2% ± 2.2%). Normalizing these by the region at risk (volume of tissue with low blood flow during the occlusion) to assess infarct ratios was also not significant (isoflurane 0.58% ± 0.08%, propofol 0.54% ± 0.07%).C Co on nc cl lu us si io on ns s: : There were no significant differences between the two anesthetic groups at day ten, suggesting that any apparent dissimilarities in early cardiovascular effects were short-term only. These results indicate that isoflurane and propofol produce equivalent long-term cardiovascular effects following ischemia/reperfusion. [isoflurane : 68,5 %± 4,2 %, propofol : 58,3 % ± 2,0 % des données de base (B) ; P = 0,04], le propofol a accéléré la récupération de la FE au jour trois (isoflurane : 63,9 % ± 4,3 %, propofol : 74,0 % ± 2,5 % de B ; P = 0,05). Au dixième jour, la FE était similaire dans les deux groupes, de même la taille de l'infarctus (isoflurane : 15,7 % ± 3,0 %, propofol : 13,2 % ± 2,2 %). La normalisation de ces données, selon la région à risque (volume de tissu soumis à un faible débit sanguin pendant l'occlusion), réalisée pour évaluer les ratios d'infarctus n'a pas été significative non plus (isoflurane : 0,58 % ± 0,08 %, propofol : 0,54 % ± 0,07 %). Objectif : Comparer les effets fonctionnels et métaboliques prolongés de l'anesthésie générale avec du propofol ou de l'isoflurane chez un modèle canin d'ischémie/reperfusion. Méthode : Nous avons mesuré, grâce aux techniques d'imagerie par résonance magnétique (IRM), le métabolisme régional (spectroscopie IRM 31P) et la fonction systolique cardiaque (IRM 1H) tout au long d'une occlusion de deux heures de l'artère descendante antérieure et...

“…65 According to Ross et al postischemic contractility recovered to a similar degree in fentanyland propofol-anesthetized dogs. 105 Cope et al reported that infarct size was smaller when rabbits were anesthetized with halothane, enflurane or isoflurane compared to pentobarbital, ketamine/xylazine or propofol. 30 Because the volatile anesthetics caused blood pressure to be lower than the iv anesthetics, the question was raised whether the difference in blood pressure was a determinant of infarct size, but there was no correlation between the two parameters within the halothane-anesthetized group.…”

Section: Neutrophil Adhesion and Migrationmentioning

confidence: 99%

Myocardial protection by anesthetic agents against ischemia-reperfusion injury: An update for anesthesiologists

Kato

Foëx

2002

196

126

P Pu ur rp po os se e: : The aim of this review of the literature was to evaluate the effectiveness of anesthetics in protecting the heart against myocardial ischemia-reperfusion injury.S So ou ur rc ce e: : Articles were obtained from the Medline database (1980-, search terms included heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflurane, isoflurane, sevoflurane, opioid, morphine, fentanyl, alfentanil sufentanil, pentazocine, buprenorphine, barbiturate, thiopental, ketamine, propofol, preconditioning, neutrophil adhesion, free radical, antioxidant and calcium).P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Protection by volatile anesthetics, morphine and propofol is relatively well investigated. It is generally agreed that these agents reduce the myocardial damage caused by ischemia and reperfusion. Other anesthetics which are often used in clinical practice, such as fentanyl, ketamine, barbiturates and benzodiazepines have been much less studied, and their potential as cardioprotectors is currently unknown. There are some proposed mechanisms for protection by anesthetic agents: ischemic preconditioning-like effect, interference in the neutrophil/platelet-endothelium interaction, blockade of Ca 2+ overload to the cytosolic space and antioxidant-like effect. Different anesthetics appear to have different mechanisms by which protection is exerted. Clinical applicability of anesthetic agent-induced protection has yet to be explored. C Co on nc cl lu us si io on n: : There is increasing evidence of anesthetic agentinduced protection. At present, isoflurane, sevoflurane and morphine appear to be most promising as preconditioning-inducing agents. After the onset of ischemia, propofol could be selected to reduce ischemia-reperfusion injury. Future clinical application depends on the full elucidation of the underlying mechanisms and on clinical outcome trials. Objectif