Effects of sevoflurane and propofol on ischaemia-reperfusion injury after thoracic-aortic occlusion in pigs.
BACKGROUND
Thoraco-abdominal-aneurysm surgery predicts high mortality. Propofol and sevoflurane are commonly used anaesthetics for this procedure. Halogenated anaesthetics induce organ protection similar to ischaemic preconditioning. We investigated which anaesthetic regimen would lead to a better protection against ischaemia-reperfusion injury induced by temporary thoracic-aortic occlusion.


METHODS
Following initial fentanyl-midazolam anaesthesia for surgical preparation, 18 pigs were randomly assigned to two groups: group one received propofol (n=9) and group two sevoflurane (n=9) before, during, and after lower body ischaemia in an investigator blinded fashion. Ten animals without aortic occlusion served as time controls (propofol, n=5; sevoflurane, n=5). For induction of ischaemia, the thoracic aorta was occluded by a balloon-catheter for 90 min. After 120 min of reperfusion, the study anaesthetics were discontinued and fentanyl-midazolam re-established for an additional 180 min. Goal-directed therapy was performed during reperfusion. Fluid and catecholamine requirements were assessed. Serum samples and intestinal tissue specimens were obtained.


RESULTS
Severe declamping shock occurred in both study groups. While norepinephrine requirements in the sevoflurane group were significantly reduced during reperfusion (P<0.05), allowing cessation of catecholamine support in 4/9 animals, all 9/9 animals were still catecholamine dependent at the end of the experiment in the propofol group. Serum activities of lactate dehydrogenase, aspartate transaminase, and alanine aminotransferase were lower with sevoflurane (P<0.05). Small intestine tissue specimens did not differ histologically.


CONCLUSIONS
Use of sevoflurane compared with propofol attenuated the haemodynamic sequelae of reperfusion injury in our model. Release of serum markers of cellular injury was also attenuated.
Annecke
T
T
Clinic of Anaesthesiology, Institute for Surgical Research, Ludwig-Maximilians-University, University Hospital, Munich, Germany.
Kubitz
J C
JC
Kahr
S
S
Hilberath
J M
JM
Langer
K
K
Kemming
G I
GI
Rehm
M
M
Bittmann
I
I
Conzen
P F
PF
D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000818:Animals; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects; D003250:Constriction; D004334:Drug Administration Schedule; D004798:Enzymes / Q000097:blood; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D007583:Jejunum / Q000473:pathology; D007773:Lactates / Q000097:blood; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D009638:Norepinephrine / Q000008:administration & dosage; D010101:Oxygen Consumption / Q000187:drug effects; D015742:Propofol / Q000627:therapeutic use*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011897:Random Allocation; D015427:Reperfusion Injury / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D000077149:Sevoflurane; D013552:Swine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004798:Enzymes; D007773:Lactates; D008738:Methyl Ethers; D014662:Vasoconstrictor Agents; D000077149:Sevoflurane; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine