Sevoflurane Inhalation at Sedative Concentrations Provides Endothelial Protection against Ischemia–Reperfusion Injury in Humans

Abstract

These data suggest that human endothelium, a key component of all vital organs, is receptive to protection by sevoflurane in vivo. Peri-ischemic administration of sevoflurane mimics a combination of pharmacologic preconditioning and postconditioning and protects at even low sedative concentrations (< 1 vol%). Inhibition of leukocyte adhesion is likely to be involved in the protection.

Remote Ischemic Preconditioning Is Redundant in Patients Undergoing Coronary Artery Bypass Graft Surgery Who Are Already Protected by Volatile Anesthetics

“…4 Using microarray analysis from atrial biopsies, we demonstrated that the release of NTpro-BNP, a marker of myocardial function/injury, clearly correlated with isoflurane-induced transcriptional changes in fatty-acid metabolism and DNA damage signaling (previously established hallmarks of isoflurane-induced transcriptional changes 5 ), but not with rIPC-induced changes. This observation and other research suggest that volatile anesthetics 6,7 and opioids 7,8 potentially attenuate or even abolish signaling from ischemia-reperfusion damage. Hence, in the presence of efficacious cardioprotective pharmacological agents such as volatile anesthetics, 9 rIPC may become redundant and may entirely lose its effectiveness, which is compatible with the recent results of the largest (so far) randomized doubleblinded study.…”

Intravenous administration of halogenated inhaled anesthetics—research tool or real application?

“…Accordingly, with the intravenous route of administration, organ protection can be achieved with inhaled agents at substantially lower concentrations than those needed to achieve anesthetic effects. These results were confirmed by Lucchinetti et al 8 who reported that sevoflurane in a sedative dose (0.5-1 vol% end-tidal concentration) inhibited leukocyte adhesion and reduced endothelial dysfunction after ischemia-reperfusion injury in healthy human volunteers. This outcome further suggests that the organ protecting concentration of halogenated ethers, in both experimental animal models and in humans, may, in fact, be lower than the anesthetic concentration.…”

The Anti-Inflammatory and Immunosuppressive Properties of Inhaled Anaesthetics - Data from Experimental Studies and Clinical Implications

“…This effect was due to reduced expression of the molecule CD11b on the surface of neutrophils. Lucchinetti E. et al studied the effect of sevoflurane used at the concentration of 0.5-1.0 vol% on the course of a 15-minute ischemiareperfusion of the upper extremity (27). The suppressed leukocyte activation was demonstrated together with the inhibition of their interaction with the vascular endothelium, assessed as the level of expression of the adhesive molecule CD 11b.…”