1
|
Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics? Cancers (Basel) 2021; 13:cancers13143390. [PMID: 34298606 PMCID: PMC8307537 DOI: 10.3390/cancers13143390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022] Open
Abstract
Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.
Collapse
|
2
|
Enlund M, Berglund A, Ahlstrand R, Walldén J, Lundberg J, Wärnberg F, Ekman A, Sjöblom Widfeldt N, Enlund A, Bergkvist L. Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia-A retrospective, multicenter, database analysis of 6305 Swedish patients. Acta Anaesthesiol Scand 2020; 64:1048-1054. [PMID: 32415980 DOI: 10.1111/aas.13644] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Retrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival. METHODS We identified all patients who were anaesthetized for breast cancer surgery between 2006 and 2012. The patients were matched to the Swedish Breast Cancer Quality Register, to retrieve tumor characteristics, prognostic factors, and adjuvant treatment as well as date of death. Overall survival between patients undergoing sevoflurane and propofol anesthesia was analyzed with different statistical approaches: (a) multiple Cox regression models adjusted for demographic, oncological, and multiple control variables, (b) propensity score matching on the same variables, but also including the participating centers as a cofactor in a separate analysis. RESULTS The database analysis identified 6305 patients. The 5-year survival rates were 91.0% and 81.8% for the propofol and sevoflurane group, respectively, in the final model (P = .126). Depending on the statistical adjustment method used, different results were obtained, from a non-significant to a "proposed" and even a "determined" difference in survival that favored propofol, with a maximum of 9.2 percentage points higher survival rate at 5 years (hazard ratio 1.46, 95% CI 1.10-1.95). CONCLUSIONS It seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.
Collapse
Affiliation(s)
- Mats Enlund
- Center for Clinical Research Västmanland Hospital Uppsala University Västerås Sweden
| | | | - Rebecca Ahlstrand
- Department of Anesthesia & Intensive Care University Hospital Örebro Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sundsvall) Umeå University Sundsvall Sweden
| | - Johan Lundberg
- Department of Anesthesiology and Intensive Care Lund University Lund Sweden
- Skane University Hospital Lund Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | | | | | - Anna Enlund
- Center for Clinical Research Västmanland Hospital Uppsala University Västerås Sweden
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Leif Bergkvist
- Center for Clinical Research Västmanland Hospital Uppsala University Västerås Sweden
| |
Collapse
|
3
|
Enlund M, Enlund A, Berglund A, Bergkvist L. Rationale and Design of the CAN Study: an RCT of Survival after Propofol- or Sevoflurane-based Anesthesia for Cancer Surgery. Curr Pharm Des 2019; 25:3028-3033. [DOI: 10.2174/1381612825666190705184218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/23/2019] [Indexed: 12/27/2022]
Abstract
Background:
Based on animal data only, some clinicians have adopted propofol-based anesthesia for
cancer surgery with the aim of increased survival.
Objective:
Our objective is to verify or refute the hypothesis that survival increases after cancer surgery with
propofol compared with sevoflurane for anesthesia maintenance. This aim deserves a large-scale randomized
study. The primary hypothesis is an absolute increase of minimum 5%-units in 1- and 5-year survival with propofol-
based anesthesia for breast or colorectal cancer after radical surgery, compared with sevoflurane-based anesthesia.
Method:
Ethics and medical agency approvals were received and pre-study registrations at clinicaltrial.gov and
EudraCT were made for our now ongoing prospective, randomized, open-label, multicenter study. A power
analysis based on a retrospective study, including a safety margin for drop outs, resulted in a total requirement of
8,000 patients. The initial inclusion period constituted a feasibility phase with an emphasis on the functionality of
the infrastructure at the contributing centers and at the monitoring organization, as well as on protocol adherence.
Conclusion:
The infrastructure and organization work smoothly at the different contributing centers. Protocol
adherence is good, and the monitors are satisfied. We expect this trial to be able to either verify or refute that
propofol is better than sevoflurane for cancer surgery.
Collapse
Affiliation(s)
- Mats Enlund
- Center for Clinical Research, Uppsala University, Vasteras, Sweden and Department of Anesthesia & Intensive Care, Central Hospital, Vasteras, Sweden
| | - Anna Enlund
- Center for Clinical Research, Uppsala University, Vasteras, Sweden and Department of Anesthesia & Intensive Care, Central Hospital, Vasteras, Sweden
| | - Anders Berglund
- Center for Clinical Research, Uppsala University, Västerås, Sweden and EpiStat, Uppsala, Sweden
| | - Leif Bergkvist
- Center for Clinical Research, Uppsala University, Vasteras, Sweden and Department of Surgery, Central Hospital, Vasteras, Sweden
| |
Collapse
|
4
|
Freire CMM, Braz MG, Marcondes JPC, Arruda NM, Braz JRC, Rainho CA, Braz LG, Salvadori DMF. Expression and promoter methylation status of two DNA repair genes in leukocytes from patients undergoing propofol or isoflurane anaesthesia. Mutagenesis 2018; 33:147-152. [DOI: 10.1093/mutage/gey001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Cristiana M M Freire
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - Mariana G Braz
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - João Paulo C Marcondes
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
- UNESP – São Paulo State University, Institute of Biosciences, Prof. Dr. Antonio Celso Wagner Zanin St., Botucatu - SP, Brazil
| | - Nayara M Arruda
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - José Reinaldo C Braz
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - Cláudia A Rainho
- UNESP – São Paulo State University, Institute of Biosciences, Prof. Dr. Antonio Celso Wagner Zanin St., Botucatu - SP, Brazil
| | - Leandro G Braz
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - Daisy M F Salvadori
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
- UNESP – São Paulo State University, Institute of Biosciences, Prof. Dr. Antonio Celso Wagner Zanin St., Botucatu - SP, Brazil
| |
Collapse
|
5
|
Oncul S, Karabiyik L, Coskun E, Kadioglu E, Gulbahar O. Comparações dos efeitos de sevoflurano e propofol sobre isquemia‐reperfusão aguda e danos ao DNA em coelhos. Braz J Anesthesiol 2017; 67:35-41. [DOI: 10.1016/j.bjan.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022] Open
|
6
|
Oncul S, Karabiyik L, Coskun E, Kadioglu E, Gulbahar O. Comparisons of the effects of the sevoflurane and propofol on acute ischemia reperfusion and DNA damages in rabbits. Braz J Anesthesiol 2016; 67:35-41. [PMID: 28017168 DOI: 10.1016/j.bjane.2015.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/17/2015] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to compare the effects of sevoflurane and propofol anesthesia on oxidative DNA damage that occurs in low-extremity ischemia and is caused by tourniquet application. METHODS Fourteen New Zealand rabbits were randomly allocated into two equal groups. Group S (n=7) received sevoflurane (2.5-4 percent) inhalation and Group P (n=7) received a propofol infusion (1-2mg·kg-1·min-1), after which a pneumatic tourniquet was placed on the right lower extremity. Blood samples were collected prior to tourniquet placement (baseline), 120min after ischemia, 15min after ischemia and 120minutes (min) after ischemia. Malondialdehyde (MDA) levels were analyzed to determine lipid peroxidation, and single cell gel electrophoresis (SCGE) was used to determine DNA damage. RESULTS At 15min after ischemia, the MDA levels in Group P (8.15±2.61μM) were higher than baseline (6.26±3.19μM, p=0.026) and Group S (4.98±0.77μM, p=0.01). DNA damage was similar in both groups, although DNA damage was higher than baseline (tail moment 0.63±0.27, tail intensity 3.76±1.26) in Group P at the 15th minute of reperfusion (tail moment 1.05±0.45, p=0.06; tail intensity 5.33±1.56, p=0.01). The increase in tail moment and tail intensity returned to normal levels in both groups 2hours after the termination of ischemia. CONCLUSION Given that oxidative stress and genotoxic effect disappear in the late stages of reperfusion, we conclude that neither sevoflurane nor propofol can be considered superior to the other in anesthesia practices for extremity surgeries involving the use of a tourniquet.
Collapse
Affiliation(s)
- Sema Oncul
- Gazi University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey.
| | - Lale Karabiyik
- Gazi University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey
| | - Erdem Coskun
- Gazi University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey
| | - Ela Kadioglu
- Gazi University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey
| | - Ozlem Gulbahar
- Gazi University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey
| |
Collapse
|
7
|
Enlund M, Berglund A, Andreasson K, Cicek C, Enlund A, Bergkvist L. The choice of anaesthetic--sevoflurane or propofol--and outcome from cancer surgery: a retrospective analysis. Ups J Med Sci 2014; 119:251-61. [PMID: 24857018 PMCID: PMC4116765 DOI: 10.3109/03009734.2014.922649] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia. PATIENTS AND METHODS Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan-Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders. RESULTS Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant. CONCLUSION Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.
Collapse
Affiliation(s)
- Mats Enlund
- Centre for Clinical Research and Department of Anaesthesia and Intensive Care, Central Hospital, Västerås, Sweden
| | - Anders Berglund
- Regional Cancer Centre (AB), Uppsala University Hospital, Uppsala, Sweden
| | - Kalle Andreasson
- Centre for Clinical Research and Department of Surgery, Central Hospital, Västerås, Sweden
| | - Catharina Cicek
- Centre for Clinical Research and Department of Surgery, Central Hospital, Västerås, Sweden
| | - Anna Enlund
- Centre for Clinical Research and Department of Anaesthesia and Intensive Care, Central Hospital, Västerås, Sweden
| | - Leif Bergkvist
- Centre for Clinical Research and Department of Surgery, Central Hospital, Västerås, Sweden
| |
Collapse
|
8
|
Braz MG, Braz LG, Mazoti MA, Pinotti MF, Pardini MIMC, Braz JRC, Salvadori DMF. Lower levels of oxidative DNA damage and apoptosis in lymphocytes from patients undergoing surgery with propofol anesthesia. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2012; 53:70-77. [PMID: 22329024 DOI: 10.1002/em.20690] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Propofol, which is widely used as an intravenous anesthetic, has a phenolic structure similar to that of α-tocopherol with antioxidant properties that could prevent genotoxicity and cytotoxicity in lymphocytes of anesthetized patients. The aims of this study were to evaluate oxidative DNA damage and apoptosis in lymphocytes and the expression of DNA repair genes in blood cells from patients undergoing elective surgery under anesthesia with propofol. Twenty healthy adults of both genders (18-50 years old) who were scheduled for otorhinological surgery were enrolled in this study. Blood samples were collected before anesthesia induction (T₁-baseline), 120 min after anesthesia induction (T₂), and on the first postoperative day (T₃). Oxidative DNA damage in peripheral lymphocytes was assessed using the comet assay. Lymphocytes were phenotyped as T helper or cytotoxic T cells, and apoptosis was evaluated using flow cytometry. The expression of DNA repair genes (hOGG1 and XRCC1) was assessed by quantitative polymerase chain reaction. A reduction in the level of oxidized purines in DNA (P < 0.01) was observed 120 min after anesthesia induction, and reduced apoptosis of T helper cells was observed 120 min after anesthesia induction and on the first postoperative day. Down-regulation of hOGG1 and XRCC1 gene expression was observed on the first postoperative day. In conclusion, patients undergoing non-invasive surgery under propofol anesthesia presented lower levels of oxidized purines and apoptosis of T helper lymphocytes. Furthermore, anesthesia with propofol did not directly influence the expression of the DNA repair genes hOGG1 and XRCC1 in blood cells.
Collapse
Affiliation(s)
- Mariana G Braz
- Departamento de Patologia, Faculdade de Medicina de Botucatu, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
9
|
Braz MG, Braz LG, Barbosa BS, Giacobino J, Orosz JEB, Salvadori DMF, Braz JRC. DNA damage in patients who underwent minimally invasive surgery under inhalation or intravenous anesthesia. Mutat Res 2011; 726:251-254. [PMID: 21944903 DOI: 10.1016/j.mrgentox.2011.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/07/2011] [Accepted: 09/08/2011] [Indexed: 05/31/2023]
Abstract
Recent studies have demonstrated the genotoxicity of anesthetics in patients who have undergone surgery and in personnel who are occupationally exposed to anesthetics. However, these findings are controversial. Herein, we used the comet assay (single-cell gel electrophoresis) to investigate the genotoxic effects of two volatile compounds [isoflurane (ISF) and sevoflurane (SVF)] that are used in inhalation anesthesia, and of one intravenous (iv) anesthetic compound [propofol (PF)]. The groups consisted of 45 patients who underwent minimally invasive surgery that lasted at least 2h. Patients were classified as physical status I using the criteria of the American Society of Anesthesiologists (ASA) and were randomly allocated to receive ISF, SVF or PF anesthesia. Venous blood samples were collected at three time points as follows: before the premedication and the induction of anesthesia (T(0)); 2h after the beginning of anesthesia (T(1)); and on the day following surgery (T(2)). DNA damage (strand breaks and alkali-labile sites) was evaluated in peripheral blood lymphocytes. For each patient, one hundred nucleoids were analyzed per time point using a semi-automated image system. Patients did not differ with respect to their demographic characteristics, the duration of surgery, or the total doses of intraoperative drugs. The amount of DNA damage was not different among the three groups before anesthesia (T(0)). No statistically significant (p>0.05) increase in DNA damage was detected during (T(1)) or after anesthesia (T(2)) using three different protocols (ISF, SVF or PF). In conclusion, general anesthesia with inhaled ISF and SVF or iv PF did not induce DNA strand breaks or alkali-labile sites in peripheral lymphocytes. Therefore, our results show that the genotoxic risk of these anesthetics, for healthy patients undergoing minimally invasive otorhinological surgery, is low or even absent.
Collapse
Affiliation(s)
- Mariana G Braz
- Univ Estadual Paulista, Departamento de Patologia, Laboratório de Toxicogenômica e Nutrigenômica, Botucatu, Brazil.
| | | | | | | | | | | | | |
Collapse
|
10
|
Schifilliti D, Mondello S, D'Arrigo MG, Chillè G, Fodale V. Genotoxic effects of anesthetic agents: an update. Expert Opin Drug Saf 2011; 10:891-9. [PMID: 21595613 DOI: 10.1517/14740338.2011.586627] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Exposure to anesthetics in the health environment may entail a health risk for patients and operating room personnel. Knowing the effects of anesthetic agents on genetic material could be a valuable basic support for anesthesia care providers to improve treatment performance, increase patient safety and reduce the risks for patients and staff in the operating room. AREAS COVERED Relevant literature was identified using MEDLINE, CINAHL® and Cochrane Library databases. Over 200 abstracts for articles published from 1980 to 2010 were examined. Original articles were reviewed and relevant citations from these articles were also considered. EXPERT OPINION Despite some conflicting results, the current available data indicate that exposure to anesthetics, especially nitrous oxide and halogenated agents, is associated with general and genotoxic risks, whereas intravenous agents, such as propofol and its metabolites are not associated with genotoxic effects. Moreover, given that different anesthetic drugs are used in combination it is, thus, very difficult to understand whether the observed effects or absence of effects are due to an individual agent action or linked to a synergy action of different anesthetics involved. Further clinical and experimental evidence is warranted.
Collapse
Affiliation(s)
- Daniela Schifilliti
- University of Messina, Department of Neuroscience , Psychiatric and Anesthesiological Sciences, Policlinico Universitario "G. Martino", Via C. Valeria, Messina , Italy
| | | | | | | | | |
Collapse
|
11
|
Evaluation of DNA damage and lipoperoxidation of propofol in patients undergoing elective surgery. Eur J Anaesthesiol 2009; 26:654-60. [PMID: 19593899 DOI: 10.1097/eja.0b013e328329b12c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Inhaled anaesthetics have been studied regarding their genotoxic and mutagenic potential in vivo. Propofol differs from volatile anaesthetics because it does not show mutagenic effects and it has been reported to be an antioxidant. However, there are no studies with propofol and genotoxicity in vivo. The study aimed to evaluate the hypothesis that propofol is not genotoxic and it inhibits lipid peroxidation [malondialdehyde (MDA)] in patients undergoing propofol anaesthesia. METHODS ASA physical status I patients scheduled for elective surgery, lasting at least 90 min, were enrolled in this study. Initially, the estimated plasma concentration of propofol was targeted at 4 microg ml(-1) and then maintained at 2-4 microg ml(-1) until the end of surgery. Haemodynamic data were determined at baseline (before premedication) and in conjunction with target-controlled infusion of propofol: after tracheal intubation, 30, 60 and 90 min after anaesthesia induction and at the end of the surgery. Venous blood samples were collected at baseline, after tracheal intubation, at the end of the surgery and on the postoperative first day for evaluating DNA damage in white blood cells (WBCs), by comet assay, and MDA levels. RESULTS Haemodynamic data did not differ among times. No statistically significant differences were observed for the levels of DNA damage in WBCs, nor in plasma MDA, among the four times. CONCLUSION Propofol does not induce DNA damage in WBCs and does not alter MDA in plasma of patients.
Collapse
|
12
|
Fodale V, Mondello S, Aloisi C, Schifilliti D, Santamaria LB. Genotoxic effects of anesthetic agents. Expert Opin Drug Saf 2008; 7:447-58. [DOI: 10.1517/14740338.7.4.447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
|
14
|
Karahalil B, Yağar S, Bahadir G, Durak P, Sardaş S. Diazepam and propofol used as anesthetics during open-heart surgery do not cause chromosomal aberrations in peripheral blood lymphocytes. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2005; 581:181-6. [PMID: 15725617 DOI: 10.1016/j.mrgentox.2004.10.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Revised: 10/05/2004] [Accepted: 10/31/2004] [Indexed: 11/25/2022]
Abstract
Diazepam is a benzodiazepine with anticonvulsant, anxiolytic, sedative and muscle-relaxing properties. Many aspects of its toxicity have been investigated, including genotoxic and carcinogenic effects in various model systems. However, it is still unclear whether diazepam is in fact a genotoxic agent. Propofol is a rapid-onset, short-acting intravenous anesthetic agent. It is used widely for the induction and maintenance of anesthesia as well as for long-term sedation in intensive care units. There is limited information in the literature on its genotoxic effects. Both drugs are commonly used as anesthetic in patients undergoing open-heart surgery. Therefore, we investigated the possible genotoxic effects of propofol and diazepam in those patients, using a chromosomal aberration (CA) assay. Peripheral blood samples were collected from 45 patients before induction of anesthesia and at the end of the anesthesia with diazepam or propofol. In Group I (n=24), anesthesia was induced with 0.2 mg kg(-1) diazepam and 10 microg kg(-1) fentanyl. In Group II (n=21), anesthesia was induced with 1 mg kg(-1) propofol and 10 microg kg(-1) fentanyl. Pancuronium bromide (0.1 mg kg(-1)) was administered for skeletal muscle relaxation in both groups. Anesthesia was maintained by diazepam administration at 5 mg kg(-1) in Group I or by continuous propofol administration at 2-4 mg (kg h)(-1) in Group II. All patients received 0.02 mg kg(-1) pancuronium and 5 microg kg(-1) fentanyl boluses at 30-40 min intervals for anesthesia maintenance. Body temperature was controlled during bypass in the two groups. We found that the mean frequency of CAs in both groups before and at the end of the anesthesia were not statistically significantly different. Our analysis also indicated that age, smoking habit and gender were not confounding factors. In conclusion, our results indicate that diazepam and propofol do not exert genotoxic effects in blood cells during open-heart surgery.
Collapse
Affiliation(s)
- B Karahalil
- Gazi University, Faculty of Pharmacy, Toxicology Department, Hipodrom, Ankara 06330, Turkey.
| | | | | | | | | |
Collapse
|