Similar articles

Abstract: Objective: We compare the cardioprotective effects of anesthetic preconditioning by propofol and/or isoflurane in rats with ischemia-reperfusion injury. Methods: Male adult Wistar rats were subjected to 60 min of anterior descending coronary artery occlusion followed by 120 min of reperfusion. Before the long ischemia, anesthetics were administered twice for 10 min followed by 5 min washout. isoflurane was inhaled at 1 MAC (0.016) in I group, whereas propofol was inhaled intravenously at 37.5 mg/(kg(h) in P group. A combination of isoflurane and propofol was administered simultaneously in I+P group. Results: In control (without anesthetic preconditioning, C group), remarkable myocardial infarction and apoptosis accompanied by an increased level of cardiac troponin T were noted 120 min after ischemia-reperfusion. As compared to those of control group, I and P groups had comparable cardioprotection. In addition, I+P group shares with I and P groups the comparable cardioprotective effects in terms of myocardial infarction and cardiac troponin T elevation. Conclusion: A combination of isoflurane and propofol produced no additional cardioprotection.

[1] Aarts, L., van der, Hee R., Dekker, I., de Jong, J., Langemeijer, H., Bast, A., 1995. The widely used anesthetic agent propofol can replace alpha-tocopherol as an antioxidant. FEBS Lett., 357(1):83-85.

[2] Ambrosio, G., Zweier, J.L., Duilio, C., Kuppusamy, P., Santoro, G., Elia, P.P., Tritto, I., Cirillo, P., Condorelli, M., Chiariello, M., 1993. Evidence that mitochondrial respiration is a source of potentially toxic oxygen free radicals in intact rabbit hearts subjected to ischemia and reflow. J. Biol. Chem., 268(25):18532-18541.

[3] Annecke, T., Kubitz, J.C., Kahr, S., Hilberath, J.M., Langer, K., Kemming, G.I., Rehm, M., Bittmann, I., Conzen, P.F., 2007. Effects of sevoflurane and propofol on ischaemia-reperfusion injury after thoracic-aortic occlusion in pigs. Br. J. Anaesth., 98(5):581-590.

[4] Baines, C.P., Cohen, M.V., Downey, J.M., 1999. Signal transduction in ischemic preconditioning: the role of kinases and mitochondrial K(ATP) channels. J. Cardiovasc. Electrophysiol., 10(5):741-754.

[5] Belhomme, D., Peynet, J., Louzy, M., Launay, J.M., Kitakaze, M., Menasché, P., 1999. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation, 100(19 Suppl.):11340-11344.

[6] Bolli, R., Patel, B.S., Jeroudi, M.O., Lai, E.K., McCay, P.B., 1988. Demonstration of free radical generation in “stunned” myocardium of intact dogs with the use of the spin trap alpha-phenyl N-tert-butyl nitrone. J. Clin. Invest., 82(2):476-485.

[7] Cason, B.A., Gamperl, A.K., Slocum, R.E., Hickey, R.F., 1997. Anesthetic-induced preconditioning: previous administration of isoflurane decreases myocardial infarct size in rabbits. Anesthesiology, 87(5):1182-1190.

[8] Choi, S.U., Lee, H.W., Lim, H.J., Yoon, S.M., Chang, S.H., 2007. The effects of propofol on cardiac function after 4 hours of cold cardioplegia and reperfusion. J. Cardiothorac. Vasc. Anesth., 21(5):678-682.

[9] Conzen, P.F., Fischer, S., Detter, C., Peter, K., 2003. Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery. Anesthesiology, 99(4):826-833.

[10] de Hert, S.G., ten Broecke, P.W., Mertens, E., van Sommeren, E.W., de Blier, I.G., Stockman, B.A., Rodrigus, I.E., 2002. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology, 97(1): 42-49.

[11] de Hert, S.G., van der Linden, P.J., Cromheecke, S., Meeus, R., Nelis, A., van Reeth, V., ten Broecke, P.W., de Blier, I.G., Stockman, B.A., Rodrigus, I.E., 2004. Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anesthesiology, 101(2): 299-310.

[12] Duranteau, J., Chandel, N.S., Kulisz, A., Shao, Z., Schumacker, P.T., 1998. Intracellular signaling by reactive oxygen species during hypoxia in cardiomyocytes. J. Biol. Chem., 273(19):11619-11624.

[13] Ebel, D., Schlack, W., Comfere, T., Preckel, B., Thamer, V., 1999. Effect of propofol on reperfusion injury after regional ischaemia in the isolated rat heart. Br. J. Anaesth., 83(6):903-908.

[14] Gopalakrishna, R., Anderson, W.B., 1989. Ca²⁺- and phospholipid-independent activation of protein kinase C by selective oxidative modification of the regulatory domain. Proc. Natl. Acad. Sci. USA, 86(17):6758-6762.

[15] Haroun-Bizri, S., Khoury, S.S., Chehab, I.R., Kassas, C.M., Baraka, A., 2001. Does isoflurane optimize myocardial protection during cardiopulmonary bypass? J. Cardiothorac. Vasc. Anesth., 15(4):418-421.

[16] Ismaeil, M.S., Tkachenko, I., Gamperl, A.K., Hickey, R.F., Cason, B.A., 1999. Mechanisms of isoflurane-induced myocardial preconditioning in rabbits. Anesthesiology, 90(3):812-821.

[17] Kersten, J.R., Schmeling, T.J., Hettrick, D.A., Pagel, P.S., Gross, G.J., Warltier, D.C., 1996. Mechanism of myocardial protection by isoflurane. Role of adenosine triphosphate-regulated potassium (K_ATP) channels. Anesthesiology, 85(4):794-807.

[18] Kersten, J.R., Schmeling, T.J., Pagel, P.S., Gross, G.J., Warltier, D.C., 1997. Isoflurane mimics ischemic preconditioning via activation of K(ATP) channels: reduction of myocardial infarct size with an acute memory. Anesthesiology, 87(2):361-370.

[19] Ko, S.H., Yu, C.W., Lee, S.K., Choe, H., Chung, M.J., Kwak, Y.G., Chae, S.W., Song, H.S., 1997. Propofol attenuates ischemia-reperfusion injury in the isolated rat heart. Anesth. Analg., 85(4):719-724.

[20] Kokita, N., Hara, A., 1996. Propofol attenuates hydrogen peroxide-induced mechanical and metabolic derangements in the isolated rat heart. Anesthesiology, 84(1): 117-127.

[21] Kokita, N., Hara, A., Abiko, Y., Arakawa, J., Hashizume, H., Namiki, A., 1998. Propofol improves functional and metabolic recovery in ischemic reperfused isolated rat hearts. Anesth. Analg., 86(2):252-258.

[22] Kowaltowski, A.J., Seetharaman, S., Paucek, P., Garlid, K.D., 2001. Bioenergetic consequences of opening the ATP-sensitive K(+) channel of heart mitochondria. Am. J. Physiol Heart Circ. Physiol., 280(2):H649-H657.

[23] Ludwig, L.M., Tanaka, K., Eells, J.T., Weihrauch, D., Pagel, P.S., Kersten, J.R., Warltier, D.C., 2004. Preconditioning by isoflurane is mediated by reactive oxygen species generated from mitochondrial electron transport chain complex III. Anesth. Analg., 99(5):1308-1315.

[24] Luo, T., Xia, Z., Ansley, D.M., Ouyang, J., Granville, D.J., Li, Y., Xia, Z.Y., Zhou, Q.S., Liu, X.Y., 2005. Propofol dose-dependently reduces tumor necrosis factor-alpha-induced human umbilical vein endothelial cell apoptosis: effects on Bcl-2 and Bax expression and nitric oxide generation. Anesth. Analg., 100(6):1653-1659.

[25] McPherson, B.C., Yao, Z., 2001a. Morphine mimics preconditioning via free radical signals and mitochondrial K(ATP) channels in myocytes. Circulation, 103(2): 290-295.

[26] McPherson, B.C., Yao, Z., 2001b. Signal transduction of opioid-induced cardioprotection in ischemia-reperfusion. Anesthesiology, 94(6):1082-1088.

[27] Mullenheim, J., Ebel, D., Frassdorf, J., Preckel, B., Thamer, V., Schlack, W., 2002. Isoflurane preconditions myocardium against infarction via release of free radicals. Anesthesiology, 96(4):934-940.

[28] Novalija, E., Fujita, S., Kampine, J.P., Stowe, D.F., 1999. Sevoflurane mimics ischemic preconditioning effects on coronary flow and nitric oxide release in isolated hearts. Anesthesiology, 91(3):701-712.

[29] Piriou, V., Chiari, P., Knezynski, S., Bastien, O., Loufoua, J., Lehot, J.J., Foex, P., Annat, G., Ovize, M., 2000. Prevention of isoflurane-induced preconditioning by 5-hydroxydecanoate and gadolinium: possible involvement of mitochondrial adenosine triphosphate-sensitive potassium and stretch-activated channels. Anesthesiology, 93(3):756-764.

[30] Quasha, A.L., Eger, E.I., Tinker, J.H., 1980. Determination and application of MAC. Anesthesiology, 53(4):315-334.

[31] Roscoe, A.K., Christensen, J.D., Lynch III, C., 2000. Isoflurane, but not halothane, induces protection of human myocardium via adenosine A1 receptors and adenosine triphosphate-sensitive potassium channels. Anesthesiology, 92(6):1692-1701.

[32] Sayin, M.M., Ozatamer, O., Tasoz, R., Kilinc, K., Unal, N., 2002. Propofol attenuates myocardial lipid peroxidation during coronary artery bypass grafting surgery. Br. J. Anaesth., 89(2):242-246.

[33] Scarabelli, T., Stephanou, A., Rayment, N., Pasini, E., Comini, L., Curello, S., Ferrari, R., Knight, R., Latchman, D., 2001. Apoptosis of endothelial cells precedes myocyte cell apoptosis in ischemia/reperfusion injury. Circulation, 104(3):253-256.

[34] Tanaka, K., Weihrauch, D., Kehl, F., Ludwig, L.M., LaDisa, J.F.Jr., Kersten, J.R., Pagel, P.S., Warltier, D.C., 2002. Mechanism of preconditioning by isoflurane in rabbits: a direct role for reactive oxygen species. Anesthesiology, 97(6):1485-1490.

[35] Tanaka, K., Weihrauch, D., Ludwig, L.M., Kersten, J.R., Pagel, P.S., Warltier, D.C., 2003. Mitochondrial adenosine triphosphate-regulated potassium channel opening acts as a trigger for isoflurane-induced preconditioning by generating reactive oxygen species. Anesthesiology, 98(4): 935-943.

[36] Toller, W.G., Kersten, J.R., Gross, E.R., Pagel, P.S., Warltier, D.C., 2000. Isoflurane preconditions myocardium against infarction via activation of inhibitory guanine nucleotide binding proteins. Anesthesiology, 92(5):1400-1407.

[37] Tomasdottir, H., Hjartarson, H., Ricksten, A., Wasslavik, C., Bengtsson, A., Ricksten, S.E., 2003. Tumor necrosis factor gene polymorphism is associated with enhanced systemic inflammatory response and increased cardiopulmonary morbidity after cardiac surgery. Anesth. Analg., 97(4):944-949.

[38] van Empel, V.P., Bertrand, A.T., Hofstra, L., Crijns, H.J., Doevendans, P.A., de Windt, L.J., 2005. Myocyte apoptosis in heart failure. Cardiovasc. Res., 67(1):21-29.

[39] Warltier, D.C., al Wathiqui, M.H., Kampine, J.P., Schmeling, W.T., 1988. Recovery of contractile function of stunned myocardium in chronically instrumented dogs is enhanced by halothane or isoflurane. Anesthesiology, 69(4): 552-565.

[40] Xia, Z., Godin, D.V., Ansley, D.M., 2004. Application of high-dose propofol during ischemia improves postischemic function of rat hearts: effects on tissue antioxidant capacity. Can. J. Physiol. Pharmacol., 82(10): 919-926.

[41] Xia, Z., Huang, Z., Ansley, D.M., 2006. Large-dose propofol during cardiopulmonary bypass decreases biochemical markers of myocardial injury in coronary surgery patients: a comparison with isoflurane. Anesth. Analg., 103(3): 527-532.

[42] Zweier, J.L., Flaherty, J.T., Weisfeldt, M.L., 1987. Direct measurement of free radical generation following reperfusion of ischemic myocardium. Proc. Natl. Acad. Sci. USA, 84(5):1404-1407.