Sevoflurane but not propofol increases interstitial glycolysis metabolites availability during tourniquet-induced ischaemia-reperfusion.
BACKGROUND
Ischaemia/reperfusion (I/R) is one of the main pathophysiological phenomena involved in the anaesthetic practice. The authors hypothesized that anaesthetic regimens can influence skeletal muscle tolerance to tourniquet-induced I/R that should be reflected by the interstitial metabolite levels of anaerobic glycolysis.


METHODS
Microdialysis probes were implanted in three groups of 10 patients each receiving either sevoflurane (SEVO), propofol (PRO), or spinal (SA) anaesthesia (for induction and maintenance). SA group was considered as a control group. Interstitial fluid was obtained during tourniquet-induced I/R and was analysed for interstitial glucose, lactate, pyruvate, and glycerol.


RESULTS
The microdialysis flow rate was 0.5 microl min(-1). Compared with the control group, the SEVO group had a higher level of both lactate and pyruvate and an increase in glucose during ischaemia. In contrast, the PRO group had a lower level of pyruvate, resulting in a significant higher increase (eight times from baseline) of the lactate pyruvate ratio. Glucose level remained low in this group. During reperfusion, lactate, pyruvate, and glucose remained at a significantly higher level in the SEVO group. In the PRO group, there was no difference in lactate, pyruvate, and glucose levels compared with the control group. The interstitial level of glycerol exhibits only few and comparable changes during I/R between the groups.


CONCLUSIONS
Our results indicate that there is a better availability of interstitial glycolysis metabolites (glucose, lactate, and pyruvate) in the skeletal muscle during ischaemia and reperfusion after sevoflurane exposure than after propofol, suggesting a potential preconditioning effect of sevoflurane on tourniquet-induced skeletal muscle I/R.
Carles
M
M
Department of Anaesthesia and Intensive Care, Archet Hospital, University of Nice, 151 Route de St Antoine Ginestière, 06202 Nice, France. carles.m@chu-nice.fr
Dellamonica
J
J
Roux
J
J
Lena
D
D
Levraut
J
J
Pittet
J F
JF
Boileau
P
P
Raucoules-Aime
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D005260:Female; D005947:Glucose / Q000378:metabolism; D005990:Glycerol / Q000378:metabolism; D006019:Glycolysis / Q000187:drug effects*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods; D007719:Knee Joint / Q000601:surgery; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D017551:Microdialysis; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000378:metabolism*; D015742:Propofol / Q000494:pharmacology*; D019289:Pyruvic Acid / Q000378:metabolism; D015427:Reperfusion Injury / Q000378:metabolism*; D000077149:Sevoflurane; D014111:Tourniquets
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D019344:Lactic Acid; D000077149:Sevoflurane; D019289:Pyruvic Acid; D005947:Glucose; D005990:Glycerol; D015742:Propofol