Effect of sevoflurane and propofol on tourniquet-induced endothelial damage: a pilot randomized controlled trial for knee-ligament surgery

Abstract

Background The glycocalyx layer is a key structure in the endothelium. Tourniquet-induced ischemic periods are used during orthopedic surgery, and the reactive oxygen species generated after ischemia-reperfusion may mediate the shedding of the glycocalyx. Here, we describe the effects of tourniquet-induced ischemia-reperfusion and compare the effects of sevoflurane and propofol on the release of endothelial biomarkers after ischemia-reperfusion in knee-ligament surgery. Methods This pilot, single-center, blinded, randomized, controlled trial included 16 healthy patients. After spinal anesthesia, hypnosis was achieved with sevoflurane or propofol according to randomization. During the perioperative period, five venous blood samples were collected for quantification of syndecan-1, heparan sulfate, and thrombomodulin from blood serum by using ELISA assays kits. Sample size calculation was performed to detect a 25% change in the mean concentration of syndecan-1 with an alpha of 0.05 and power of 80%. Results For our primary outcome, a two-way ANOVA with post-hoc Bonferroni correction analysis showed no differences in syndecan-1 concentrations between the sevoflurane and propofol groups at any time point. In the sevoflurane group, we noted an increase in syndecan-1 concentrations 90 min after tourniquet release in the sevoflurane group from 34.6 ± 24.4 ng/mL to 47.9 ± 29.8 ng/mL (Wilcoxon test, p < 0.01) that was not observed in patients randomized to the propofol group. The two-way ANOVA showed no intergroup differences in heparan sulfate and thrombomodulin levels. Conclusions Superficial endothelial damage without alterations in the cell layer integrity was observed after tourniquet knee-ligament surgery. There was no elevation in serum endothelial biomarkers in the propofol group patients. Sevoflurane did not show the protective effect observed in in vitro and in vivo studies. Trial registration The trial was registered in www.clinicaltrials.gov (ref: NCT03772054, Registered 11 December 2018).

Effect of volatile and total intravenous anesthesia on syndecan-1 shedding after minimally invasive gastrectomy: a randomized trial

“…Our study showed that the serum concentration of syndecan-1 was significantly increased at POD 1 compared to preoperative levels, and that the increase was comparable between patients under volatile anesthesia with sevoflurane/remifentanil and those under TIVA with propofol/remifentanil. Our results further confirmed previous findings indicating that sevoflurane and propofol have similar effects regarding perioperative EG degradation 9 , 10 .…”

“…Sevoflurane was superior to propofol in protecting the EG from I/R injury in a porcine model 16 . In contrast to experimental results, sevoflurane did not show a better protective effect on the EG than propofol in clinical studies of lung resection surgery and knee-ligament surgery 9 , 10 .…”

“…Moreover, sevoflurane significantly reduced heparan sulfate shedding after I/R injury compared to propofol by reducing the generation of unmeasured anions 16 . However, contradictory to the reported protective effects of sevoflurane on EG damage in animal models 14 – 16 , sevoflurane was not superior to propofol in reducing EG degradation in surgical patients 9 , 10 . In lung resection surgery with one lung ventilation, no difference was observed in heparan sulfate and syndecan-1 concentrations between sevoflurane and propofol groups during surgery 9 .…”

“…In lung resection surgery with one lung ventilation, no difference was observed in heparan sulfate and syndecan-1 concentrations between sevoflurane and propofol groups during surgery 9 . Likewise, no difference existed in heparan sulfate and syndecan-1 concentrations between the two groups up to 90 min after tourniquet release in knee-ligament surgery 10 . These two studies presented design differences compared to our study: sevoflurane or propofol alone was used for general anesthesia maintenance without concomitant use of opioids 9 , and sevoflurane or propofol was used for hypnosis under spinal anesthesia 10 .…”

Science‐in‐brief: The role of the glycocalyx in critically ill patients with reference to the horse

“…As mentioned, judicious fluid therapy and use of plasma or albumin have been proposed but require further investigation. Inhalation anaesthesia using sevoflurane has been suggested to have glycocalyx‐protecting or regenerating effects in some studies 39,40 but this was not confirmed by others 22,41 . Other drugs with possible benefits include corticosteroids, antithrombin, heparin and heparinoids 42 .…”