Adding Emulsified Isoflurane to Cardioplegia Solution Produces Cardiac Protection in a Dog Cardiopulmonary Bypass Model

Abstract

This study investigated whether caridoplegia solution with Emulsified Isoflurane (EI) could improve cardiaoprotection in a dog CPB model of great similarity to clinical settings. Adult dogs were randomly assigned to receive one of the following cardioplegia solutions: St. Thomas with EI (group ST+EI), St. Thomas with 30% Intralipid (group ST+EL) and St. Thomas alone (group ST). The aorta was cross-clamped for two hours followed by reperfusion for another two hours, during which cardiac output was measured and dosages of positive inotropic agent to maintain normal hemodynamics were recorded. Serum level of cardiac troponin I (cTnI) and CK-MB were measured. Deletion of cardiac mitochondrial DNA was examined at the end of reperfusion. Compared with ST, ST+EI decreased the requirement of dopamine support while animals receiving ST+EI had a significantly larger cardiac output. ST+EI reduced post-CPB release of cTnI and CK-MB. Mitochondrial DNA loss was observed in only one of the tested animals from group ST+EI while it was seen in all the tested animals from group ST+EL and ST. Addition of emulsified isoflurane into cardioplegia solution protects against myocardial ischemia reperfusion injury. This protective effect might be mediated by preserving mitochondrial ultrastructure and DNA integrity.

Deficiency of Interleukin-36 Receptor Protected Cardiomyocytes from Ischemia-Reperfusion Injury in Cardiopulmonary Bypass

“…Huang et al found that, compared with dopamine treatment in cardioplegia, isoflurane addition increased cardiac output more effectively. ST+EI was reported to decrease the release of cTni and CK-MB following CPB [25]. Emulsified isoflurane was combined with cardioplegia to prevent I/R injury.…”

Efficacy of propofol-supplemented cardioplegia on biomarkers of organ injury in patients having cardiac surgery using cardiopulmonary bypass: A protocol for a randomised controlled study (ProMPT2)

“…Sweden) is also potentially cardioprotective. [12][13][14] Therefore, in this study saline will be used instead as a placebo.…”

The Bioequivalence of Emulsified Isoflurane With a New Formulation of Emulsion: A Single-Center, Single-Dose, Double-Blinded, Randomized, Two-Period Crossover Study

“…EI has greater C max and AUC (Yang et al, 2013). At some doses, the exposure of EI was greater than that of isoflurane (Huang et al, 2016;Wang et al, 2016;Yang et al, 2020;Zhao et al, 2020). In general, EI combines the advantages of both volatile and intravenous anesthetics (Huang et al, 2014), making it valuable in the clinical application (Zhou and Liu 2012).…”

“…Second, EI does not need the lung uptake to take effects; it also avoids the dilution of the drug resulting from the respiratory circuit and functional alveolar residue capacity; therefore, induction is faster ( Yang et al, 2008 ). Third, EI is eliminated mostly via expiration; anesthesia level can be easily controlled by injection speed and ventilation adjustment in the stage of anesthesia maintenance and emergence ( Huang et al, 2010 ; Zhou, et al, 2011b ; Huang et al, 2016 ; Wang et al, 2016 ; Yang et al, 2020 ; Zhao et al, 2020 ). Fourth, EI is more potent than isoflurane.…”