Isoflurane Produces Delayed Preconditioning against Myocardial Ischemia and Reperfusion Injury

Tanaka, Katsuya; Ludwig, Lynda M.; Krolikowski, John G.; Alcindor, Dunbar; Pratt, Phillip F.; Kersten, Judy R.; Pagel, Paul S.; Warltier, David C.

doi:10.1097/00000542-200403000-00010

Cited by 101 publications

(79 citation statements)

References 21 publications

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“…In addition to a sufficient revascularization, elective myocardial protection is needed for the ventricular function to be maintained. There are various factors affecting postoperative myocardial function and extent of myocardial injury (6,7). Despite the great number of studies conducted, the mechanism of action of volatile anesthetic agents with regard to myocardial injury is not entirely elucidated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

Ceyhan

Tanriverdi²,

Bilir³

2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Bu prospektif randomize çalışmanın amacı sevofluran ve isofluranın koroner baypas cerrahisi sırasında miyokart üzerindeki koruyucu etkilerini karşılaştırmaktır. Yöntemler: Etomidat (0.3 mg /kg ) ile genel anestezi indüksiyonunu takiben 0.1 mg/kg pankuronyum ve 1 mikrogr/kg remifentanil bolus olarak verildi. Anestezi idamesi Grup 1'deki hastalarda (n=20) %2-4 değerinde sevofluran, Grup 2'deki hastalarda (n=20) %1-2 değerinde isofluranla sağlandı. Anestezi indüksiyonundan önce, aortik klemp kaldırıldıktan sonra ve postoperatif periyotta arteriyel kan örnekleri alındı. Bu örneklerde Troponin T, kreatinin kinaz ve kreatinin kinaz MB değerleri ölçüldü. İstatistiksel analizler -iki-yönlü ANOVA ve Mann-Whitney testleri ile yapıldı. Bulgular: Kalp hızı sevofluran grubunda pompa periyodunda, pompadan çıkış sonrası 10. ve 20. dakikalarda anlamlı yüksek bulunmuştur. CKMB düzeyi postoperatif 24. saatte sevofluran grubunda isofluran grubuna göre anlamlı düşüktür. Troponin T kros-klemp kaldırıldıktan sonra (1.015 (0.935-1.850) ng/ml, 1.469 (1.290-1.645) ng/ml, p<0.001) ve postoperatif 24.saatte (5.345±0.654 ng/ml, 8.715±1.020 ng/ml, p<0.001) sevofluran grubunda isofluran grubu ile karşılaştırıldığında anlamlı düşüktür. Sonuç: Miyokardiyal hasarlanma işaretleyicileri olan troponin T ve CKMB düzeylerinin daha düşük düzeylerde saptanması ile sevofluranın isoflurana göre miyokardiyal korumayı daha iyi sağlamakta olduğu kanısındayız. (Anadolu Kardiyol Derg 2011; 11: 257-62) Anahtar kelimeler: Sevofluran, isofluran, miyokardiyal koruma, koroner baypas cerrahisi ABSTRACT Objective: The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery. Methods: After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2%. Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test. Results: Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10 th minute and 20 th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24 th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24 th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group. Conclusion: Sevoflurane provides a better myocardial protection than isof...

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Section: Discussionmentioning

confidence: 99%

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

Ceyhan

Tanriverdi²,

Bilir³

2011

Anadolu Kardiyol Derg

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“…На сегодня известна роль ЦОГ 2 в реализации эффектов поздней фазы ишемического прекондиционирования, а инги биторы этого фермента, которые в последнее время нашли ши рокое применение в клинической практике, могут блокировать защитные эффекты как ишемического, так и анестетического прекондиционирования [29].…”

Section: блокада ишемического и фармакологического прекондиционированияunclassified

Ischemic and Pharmacological Preconditioning (part 2)

Лихванцев¹,

Мороз²,

Гребенчиков³

et al. 2012

rmt

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“…Among these agents, several studies show that the halogenated anesthetics are capable of promoting post-conditioning directly, or increasing indirectly the ischemic pre-and postconditioning against ischemia and reperfusion injuries 12,14,17 . This mechanism is not totally clear yet, but is seems to mimic ischemic pre-conditioning.…”

Section: Anesthetic Pre-and Post-conditioningmentioning

confidence: 99%

“…Nowadays it is quite evident that the effect is actually direct, and it involves the activation of various intracellular pathways that will promote protection against dysfunction and myocardial necrosis. Both the ischemic and the anesthetic pre-conditioning in the heart present the same cellular mechanism, which involves the activation of the mitochondrial and sarcolemma K ATP -dependent channels, resulting in overload decrease in the mitochondrial and myoplasmatic calcium 7,[17][18][19] . Additionally, studies have shown that the halogenated anesthetics promote protection against ischemia-reperfusion injuries by pre-conditioning blood vessels, protecting against vascular injuries and impeding the endothelium contribution to the pro-inflammatory and thrombogenic events related to ischemia-reperfusion injuries 20 .…”

Section: Anesthetic Pre-and Post-conditioningmentioning

confidence: 99%

Uso de anestésicos halogenados na circulação extracorpórea

Neto¹,

Tardelli²,

Paulista³

2012

Rev. Bras. Anestesiol.

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Isoflurane Produces Delayed Preconditioning against Myocardial Ischemia and Reperfusion Injury

Abstract: The results indicate that the volatile anesthetic isoflurane produces a second window of preconditioning against myocardial ischemia and reperfusion injury. Furthermore, COX-2 is an important mediator of isoflurane-induced delayed preconditioning.

Cited by 101 publications

References 21 publications

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

Ischemic and Pharmacological Preconditioning (part 2)

Uso de anestésicos halogenados na circulação extracorpórea

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