The effects of etomidate, thiopental, and propofol in induction on hypoperfusion-reperfusion phenomenon during laparoscopic cholecystectomy.
BACKGROUND
A hypoperfusion-reperfusion human model is observed during and soon after laparoscopic surgery. The aim of the study was to research the preventive effects of etomidate, thiopental, and propofol in induction on hypoperfusion- reperfusion phenomenon during laparoscopic cholecystectomy.


METHODS
Thirty-six consecutive ASA I-II patients were randomized into three groups of 12 patients each. Anaesthesia was induced with etomidate in group 1, thiopental in group 2, and propofol in group 3. Venous blood samples were obtained at different time points for measurement of plasma malondialdehyde (MDA) levels. Arterial blood and gastric juice samples were obtained for the calculation of gastric intramucosal pH (pHi). Also changes in aminotransferases, alkaline phosphatase and total bilirubin levels were assessed.


RESULTS
There was a significant decrease in pHi at 1 min before desufflation (BD) and 20 min after desufflation (AD) compared with before insufflation (BI) in all groups. Plasma level of MDA was significantly increased in group 1 at 1 min BD and 20 min AD compared with before induction of anaesthesia (baseline). Malondialdehyde levels were decreased significantly in group 3 and increased non-significantly in group 2 at the same time points. Also AST and ALT levels were significantly increased in both groups 1 and 2 at 24 h postoperatively.


CONCLUSIONS
Propofol with antioxidant activity may offer many advantages by scavenging reactive oxygen species and their metabolites in case of anticipated hypoperfusion-reperfusion phenomenon, such as would occur in laparoscopic surgery.
Yagmurdur
H
H
The Ministry of Health Ankara Research and Training Hospital, Clinic of Anesthesiology and Reanimation, Ankara, Turkey. mcyagmurdur@hotmail.com
Cakan
T
T
Bayrak
A
A
Arslan
M
M
Baltaci
B
B
Inan
N
N
Kilinc
K
K
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood / Q000187:drug effects; D000469:Alkaline Phosphatase / Q000097:blood / Q000187:drug effects; D000704:Analysis of Variance; D018686:Anesthetics, Intravenous / Q000097:blood / Q000494:pharmacology; D001219:Aspartate Aminotransferases / Q000097:blood / Q000187:drug effects; D001663:Bilirubin / Q000097:blood; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005045:Etomidate / Q000097:blood / Q000494:pharmacology*; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007327:Insufflation / Q000379:methods; D015227:Lipid Peroxidation / Q000187:drug effects; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D015742:Propofol / Q000097:blood / Q000494:pharmacology*; D015427:Reperfusion Injury / Q000517:prevention & control*; D013874:Thiopental / Q000097:blood / Q000494:pharmacology*; D013997:Time Factors
D018686:Anesthetics, Intravenous; D008315:Malondialdehyde; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D013874:Thiopental; D001663:Bilirubin; D015742:Propofol; D005045:Etomidate