Does remifentanil attenuate renal ischemia–reperfusion injury better than dexmedetomidine in rat kidney?

Abstract

BackgroundIschemia–reperfusion (I/R) injury is a common cause of patient morbidity and mortality in the perioperative period. Patients undergoing long-lasting, abdominal, and urogenital surgeries with risk factors such as advanced age, peripheral artery disease, diabetes mellitus, renovascular disease, and congestive heart failure are candidates for acute kidney injury (AKI) due to impaired renal perfusion and decreased functional renal reserve. Pharmacological agents with multiple functions and anti-oxidative and anti-inflammation properties may be promising preventative strategies for AKI. Recently, dexmedetomidine (dex) has been postulated to have renoprotective effects.ObjectivesWe aimed to investigate the protective effects of an intravenous anesthetic remifentanil in renal I/R injury in the rat in comparison with dex.Materials and methodsA total of 30 Sprague Dawley adult rats were randomly assigned into five groups: the control group (group C, n=6), the sham group (group Sh, n=6, saline-infused rats without I/R injury), the saline group (group S, n=6, saline-infused rats with I/R injury), the remifentanil-treated group (group REM, n=6), and the dexmedetomidine-treated group (group DEX, n=6). The infusions (saline, remifentanil, and dex) were started after anesthesia induction and right nephrectomy and continued until the end of the surgical procedure. In I/R injury groups, the left renal artery and vein were occluded together by a clamp for 30 minutes and reperfusion lasted for 30 minutes. The rats were sacrificed after reperfusion, and the left kidney tissue was harvested. Blood samples were drawn from all animals to evaluate plasma neutrophil gelatinase-associated lipocalin (NGAL) at the beginning, 15 minutes after ischemia, 15 minutes after reperfusion, and 6 hours after the surgical procedure (T0, T1, T2, and T3, respectively).ResultsThe plasma NGAL levels exhibited increase at T1, T2, and T3 compared to the levels at T0 in group S (P<0.05). In group REM, there was a significant increase in plasma NGAL levels at T3 in comparison to those at T0, T1, and T2. The plasma NGAL levels at T2 in group S were significantly higher than those at T2 in group DEX (P<0.05). The groups S and REM showed significantly higher plasma NGAL levels at T3 compared to those at T0 (P<0.05). Upon histological examination, there was no difference among the study groups when left kidneys were evaluated (P>0.05).ConclusionThe NGAL levels and histopathological findings reflected protection by dex against renal I/R injury. However, the same exact results could not be mentioned for remifentanil depending on our study results.

Perioperative Dexmedetomidine Improves Outcomes of Kidney Transplant

“…[39][40][41] Subsequently, Dex could also suppress toll-like receptor 4 signaling, activate the cholinergic anti-inflammatory pathway, and intensify macrophage phagocytosis for bacterial clearance, thus stabilizing hemodynamics. [42][43][44] Acute kidney allograft rejection occurs as a consequence of interactions between recipient immune cells within the transplanted organ as is the cause of 64% of renal transplantation failures. 45 The immune system and inflammation play vital roles in the development of this disorder.…”

“…The mechanism has been suggested as Dex reducing the release of inflammatory cytokines, such as TNF and IL‐6, by inhibiting the activation of ERK1/2 and NF‐κB and modulating inflammatory mediators 39–41 . Subsequently, Dex could also suppress toll‐like receptor 4 signaling, activate the cholinergic anti‐inflammatory pathway, and intensify macrophage phagocytosis for bacterial clearance, thus stabilizing hemodynamics 42–44 …”

Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model

“…We observed that remifentanil did not prevent lung injury as a distant organ in infrarenal I/R. In our previous study, Erkılıç et al [ 35 ] compared the protective effects of remifentanil and dexmedetomidine (DEX) on renal I/R injury. We have demonstrated that neutrophil gelatinase-associated lipocalin (NGAL) levels and histopathological findings reflected protection by DEX against renal I/R injury while remifentanil was not as effective as DEX.…”

Effects of propofol on the inflammatory response during robot-assisted laparoscopic radical prostatectomy: a prospective randomized controlled study

“…The amount of remifentanil infused in the propofol group was significantly greater than that infused in the desflurane group, and this may have increased the intraoperative urine output. Although the renoprotective effects of remifentanil have been investigated at various doses, a dose of 0.1–2 mcg/kg/min was found to exhibit renoprotective effects in previous studies of IRI 49–51 . Accordingly, the doses of remifentanil used in the propofol (0.1 mcg/kg/min) and desflurane (0.07 mcg/kg/min) groups in the present study were somewhat lower than the effective dose affecting stress hormones and inflammatory responses.…”