Protective effect of sevoflurane preconditioning on ischemia-reperfusion injury in patients undergoing reconstructive plastic surgery with microsurgical flap, a randomized controlled trial

Abstract

BackgroundIn many clinical conditions that involve free flaps and tissue transplantations the possibility of minimizing ischemia-reperfusion injury can be a determinant factor for the success of the surgery itself. We hypothesize that preconditioning with sevoflurane is a protective factor against ischemia-reperfusion injury.MethodsIn this randomized controlled trial, patients ASA I-II undergoing breast reconstruction with deep inferior epigastric perforator flaps were allocated into two groups and analyzed: group BAL included patients who received balanced anesthesia with sevoflurane for 30 min before removal of the flap and throughout the surgery. The TCI group included patients who received a total intravenous anesthesia with propofol and remifentanil. We evaluated regional tissue oximetry at the end of the surgery and at 4, 12 and 20 h after surgery. Other assessed parameters were: blood lactate clearance, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, creatine phosphokinase.ResultsIn total 54 patients, twenty-seven per group, were analyzed. There was a significant increase of the average value of regional tissue oximetry measured 4 h after surgery in the BAL group compared to the TCI group: BAL: 84.05 % (8.96 SD); TCI : 76.17 % (12.92 SD) (P = 0.03), but not at the other time frames. The creatine phosphokinase value was significantly lower in the BAL group at the end of surgery, but not at the other time-frames. There were no significant differences in blood levels of other markers.ConclusionsFrom our results, the positive preconditioning impact of sevoflurane on ischemia-reperfusion injury in patients undergoing free flap surgery is expressed in the early postoperative hours, but it does not persist in the long-term.Trial registrationClinicalTrial.gov identifier: NCT01905501. Registered July 18, 2013

Sevoflurane Pre-conditioning Ameliorates Diabetic Myocardial Ischemia/Reperfusion Injury Via Differential Regulation of p38 and ERK

“…Sevoflurane exhibited favorable effects in animal experiments, but clinical evidence indicated no survival difference between diabetic and non-diabetic groups 11 . However, Sevoflurane preconditioning cardioprotection is undoubted in clinical applications [32][33][34] . Our study demonstrates that preconditioning can directly positively influence cell survival signaling (MAPK) in the diabetic condition, rescuing the energetic pathway independently of endogenously suppressed metabolism.…”

Impact of Anesthetic Agents on Endothelial Glycocalyx Injury during Total Knee Arthroplasty: Desflurane- vs. Propofol-Based Anesthesia—A Prospective Randomized Controlled Trial

“…Volatile anesthetics attenuated IRI-related endothelial destruction in some animal studies [ 13 – 15 ]. However, clinical studies investigating the endothelial protective effect of volatile anesthetics show conflicting results [ 16 , 17 ]. In addition, few clinical studies revealed the different effect of volatile anesthetics and propofol in terms of endothelial protection against IRI during TKA.…”

Pharmacological preconditioning protects from ischemia/reperfusion‐induced apoptosis by modulating Bcl‐xL expression through a ROS‐dependent mechanism

“…In recent years, significant developments have been made in understanding the mechanisms of I/R injury and in developing strategies to make myocardial tissue more resistant to ischemia or to limit reperfusion injuries [4]. Among these cardioprotection strategies, APc with halogenated agents, of which SEV, has proven its effectiveness in both animals [40] and humans [41,42]. However, the way in which APc contributes to the reported myocardial protection remains largely unknown.…”