Sevoflurane, Propofol and Carvedilol Block Myocardial Protection by Limb Remote Ischemic Preconditioning

Abstract

The effects of remote ischemic preconditioning (RIPC) in cardiac surgery have been inconsistent. We investigated whether anesthesia or beta-blockers interfere with RIPC cardioprotection. Fifty patients undergoing cardiac surgery were randomized to receive limb RIPC (four cycles of 5-min of upper arm cuff inflation/deflation) in the awake state (no-anesthesia; n = 17), or under sevoflurane (n = 17) or propofol (n = 16) anesthesia. In a separate crossover study, 11 healthy volunteers received either carvedilol or no medication prior to RIPC. Plasma dialysates were obtained and perfused through an isolated male Sprague–Dawley rat heart subjected to 30-min ischemia/60-min reperfusion, following which myocardial infarct (MI) size was determined. In the cardiac surgery study, pre-RIPC MI sizes were similar among the groups (39.7 ± 4.5% no-anesthesia, 38.9 ± 5.3% sevoflurane, and 38.6 ± 3.6% propofol). However, post-RIPC MI size was reduced in the no-anesthesia group (27.5 ± 8.0%; p < 0.001), but not in the anesthesia groups (35.7 ± 6.9% sevoflurane and 35.8 ± 5.8% propofol). In the healthy volunteer study, there was a reduction in MI size with RIPC in the no-carvedilol group (41.7 ± 4.3% to 30.6 ± 8.5%; p < 0.0001), but not in the carvedilol group (41.0 ± 4.0% to 39.6 ± 5.6%; p = 0.452). We found that the cardioprotective effects of limb RIPC were abolished under propofol or sevoflurane anesthesia and in the presence of carvedilol therapy.

Remote ischemic preconditioning attenuates intestinal mucosal damage: insight from a rat model of ischemia–reperfusion injury

“…Several authors suggested that anesthesia is a confounder of organprotection by RIPC especially in the heart and that propofol anesthesia impairs the cardioprotective effect of RIPC [33, 34]. According to a meta-analysis by Zhou et al and a recently published study by Cho et al use of volatile anesthetics also attenuates the cardioprotection afforded by RIPC [35, 36]. Although, no studies have so far investigated whether or not anesthesia is also a confounder of intestinal protection by RIPC, we cannot rule out this possibility.…”

Demethylation of <em>HACE1</em> gene promoter by propofol promotes autophagy of human A549&nbsp;cells

“…Anesthetics are important chemical drugs that allow patients to undergo operations involving severe pain where the patient must not move, such as dental treatment ( 1 , 2 ). Propofol (2,6-diisopropylphenol) is one of the most commonly used intravenous anesthetics globally as the depth of anesthesia induced by propofol can be controlled to a greater degree compared with other anesthetics, such as midazolam, etomidate, thiopental sodium and ketamine ( 1 , 3 – 5 ). At the same time, propofol possesses a number of non-anesthetic effects, including antitumor function, which has been widely reported ( 6 , 7 ).…”

Update of the organoprotective properties of xenon and argon: from bench to beside

“…Recently, research focused on the impact of propofol on promoting/inhibiting remote-ischaemic preconditioning, anaesthetic organ protection, neuroprotection by reducing/increasing POD, etc. [55,[129][130][131][132][133].…”