title: Protective effect of sevoflurane preconditioning on ischemia-reperfusion injury in patients undergoing reconstructive plastic surgery with microsurgical flap, a randomized controlled trial.
abstract: In many clinical conditions that involve free flaps and tissue transplantations the possibility of minimizing ischemia-reperfusion injury can be a determinant factor for the success of the surgery itself. We hypothesize that preconditioning with sevoflurane is a protective factor against ischemia-reperfusion injury.
  
  
  
  In this randomized controlled trial, patients ASA I-II undergoing breast reconstruction with deep inferior epigastric perforator flaps were allocated into two groups and analyzed: group BAL included patients who received balanced anesthesia with sevoflurane for 30 min before removal of the flap and throughout the surgery. The TCI group included patients who received a total intravenous anesthesia with propofol and remifentanil. We evaluated regional tissue oximetry at the end of the surgery and at 4, 12 and 20 h after surgery. Other assessed parameters were: blood lactate clearance, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, creatine phosphokinase.
  
  
  
  In total 54 patients, twenty-seven per group, were analyzed. There was a significant increase of the average value of regional tissue oximetry measured 4 h after surgery in the BAL group compared to the TCI group: BAL: 84.05 % (8.96 SD); TCI : 76.17 % (12.92 SD) (P = 0.03), but not at the other time frames. The creatine phosphokinase value was significantly lower in the BAL group at the end of surgery, but not at the other time-frames. There were no significant differences in blood levels of other markers.
  
  
  
  From our results, the positive preconditioning impact of sevoflurane on ischemia-reperfusion injury in patients undergoing free flap surgery is expressed in the early postoperative hours, but it does not persist in the long-term.
  
  
  
  ClinicalTrial.gov identifier: NCT01905501 . Registered July 18, 2013.
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy. claroni@icloud.com.
authors.forename: Claudia
authors.identifier: 0000-0003-2694-0183
authors.initials: C
authors.lastname: Claroni
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Torregiani
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Covotta
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Sofra
authors.affiliation: School of medicine, University Hospital Center Tor Vergata, V.le Oxford 81, 00133, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Scotto Di Uccio
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Marcelli
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Naccarato
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, V. Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Forastiere
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D016462:Mammaplasty / Q000379:methods*; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D010092:Oximetry; D010880:Piperidines / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D015427:Reperfusion Injury / Q000517:prevention & control*; D000077149:Sevoflurane; D013524:Surgical Flaps; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D015415:Biomarkers; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol
keywords: Free flap; Ischemia reperfusion injury; Near infrared spettroscopy; Preconditioning; Sevoflurane