Delayed Inhibition of Agonist-Induced Granulocyte-Platelet Aggregation After Low-Dose Sevoflurane Inhalation in Humans

Wacker, Jürgen; Lucchinetti, Eliana; Jamnicki, Marina; Aguirre, José; Härter, Luc; Keel, Marius; Zaugg, Michael

doi:10.1213/ane.0b013e318172f9e9

Cited by 16 publications

(13 citation statements)

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“…21 The same low concentration inhibits agonist-induced granulocyte-platelet interactions up to 24 hours after administration and thus counteracts the thromboinflammatory processes. 22 Sevoflurane was found to be cardioprotective in patients undergoing cardiac surgery. [10][11][12][13] In the current study, we did not find a difference in the degree of myocardial injury between the sevoflurane and the control groups.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane in acute myocardial infarction: A pilot randomized study

Lavi

Bainbridge

D'Alfonso

et al. 2014

American Heart Journal

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Section: Discussionmentioning

confidence: 99%

Sevoflurane in acute myocardial infarction: A pilot randomized study

Lavi

Bainbridge

D'Alfonso

et al. 2014

American Heart Journal

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“…We are unable to comment on the clinical value of these changes due to our limited sample size, but further study is merited as sevoflurane has been shown to inhibit platelet aggregation induced by adenosine diphosphate [9,10].…”

Section: Discussionmentioning

confidence: 93%

Platelet Function as Affected by Total Intravenous and Inhalational Anesthesia

Cattano

Gomez-Rivera

Seitan

et al. 2013

J Anesthe Clinic Res

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Propofol is a frequent choice of hypnotic anesthetic for TIVA due to its role as a vasodilator [1]. The advantages for ESS of a lower patient blood pressure, however, may be negated by reports that propofol has an adverse effect on blood coagulation [1][2][3][4][5][6]. The choice of anesthesia regimen is further complicated by research indicating inhalational anesthetics also inhibit platelet aggregation [5,6].The purpose of this study was to investigate the potential differences in effects of two anesthesia regimens by measuring blood loss and platelet function. It was our hypothesis that, for the purposes of ESS, TIVA with propofol/remifentanyl would result in reduced blood loss than inhalational anesthesia with sevoflurane/remifentanyl. MethodsThis study was registered with the National Institutes of Health and can be found at http://clinicaltrials.gov/ct2/show/NCT01214057. After obtaining approval from the Committee for the Protection of Human Subjects, 23 patients aged 18-80, American Society of Anesthesia (ASA) grade I or II, scheduled to undergo endoscopic sinus surgery (ESS) for chronic rhinosinusitis were screened, consented and enrolled. Exclusion criteria included known coagulopathy or use of any drug that could affect thrombocyte function (e.g., aspirin, clopidogrel). Anesthetic ProtocolPatients were randomly assigned using a blocked randomization method to receive either propofol/remifentanil (PR, n=12) or sevoflurane/remifentanil (SR, n=11) general anesthesia. Both patients and surgeons were blinded to the type of anesthetic used. Patients were premedicated in the holding area with dexamethasone and midazolam. The patients were monitored by American Society of Anesthesia (ASA) standards with ECG, non-invasive blood pressure, pulse oximetry and temperature probe. Their blood pressure was recorded every 2 minutes for the first 10 minutes, then every 5 minutes.In order to reduce the visual bias of a propofol infusion, anesthesia was induced in both SR and PR groups with lidocaine 0.5 mg/kg, propofol infusion at 250 mcg/kg/min and total volume infused was adjusted for an induction dose of 2-3 mg/kg before bolus of muscle relaxant, rocuronium 0.5 mg/kg. Remifentanil infusion was started at a rate of 0.4 mcg/kg/min one to two minutes before the propofol infu- AbstractBackground: Few studies have attempted to demonstrate a benefit of a total intraveneous anesthesia (TIVA) as the sole technique to optimize and reduce bleeding. Also few reports have linked the use of propofol to platelet dysfunction, and while Thromboelastography (TEG ® ) has been used previously, its complement platelet mapping (PM™) has not. The aim of the study was to exclude different causes for blood loss during surgery, including drug effects on platelet function. Methods:After IRB approval, we studied 23 patients scheduled to undergo endoscopic sinus surgery. Using a double-blind experimental method, we randomly assigned patients to receive either TIVA with propofol/remifentanil (PR) or inhalational anesthesia with sevoflurane/remi...

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“…Full anesthetic doses of halogenated ethers may not be required to see these effects, since sub-anesthetic doses can decrease plateletneutrophil interactions in human subjects. 11 With the use of any drug in in-vivo models, unintentional effects must be assumed, and controlling for these effects is difficult. Animals not receiving isoflurane received sodium pentobarbital as an anesthetic.…”

Section: Discussionmentioning

confidence: 99%

“…8 These volatile gasses are known to prevent neutrophil adhesion to the endothelium, 9,10 but the exact mechanism remains unclear. Recently, sub-anesthetic doses of sevoflurane have been shown to inhibit granulocyte-platelet interactions, 11 suggesting a possible reagent to uncouple coagulation and the maladaptive innate immunity in ALI/ARDS. Thus, platelets appear to have a role in the pathogenesis of ALI via a response to the initial insult resulting in neutrophil activation and release of inflammatory mediators.…”

Section: Introductionmentioning

confidence: 99%