Sevoflurane preconditioning attenuates the fall in adenosine triphosphate levels, but does not alter the changes in sodium and potassium levels during hypoxia in rat hippocampal slices. Anesthesiology. 2013;119:119-128. [PMID: 23459218 DOI: 10.1097/ALN.0b013e31828ce844]

Protective effect of sevoflurane preconditioning on ischemia-reperfusion injury in patients undergoing reconstructive plastic surgery with microsurgical flap, a randomized controlled trial

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Trial registration

ClinicalTrial.gov identifier: NCT01905501. Registered July 18, 2013

Effect of sevoflurane preconditioning on the digestive system of patients with primary liver cancer undergoing surgery

AIM: To explore the effect of sevoflurane preconditioning on the digestive system of patients with primary liver cancer undergoing surgery.

METHODS: Eighty patients who underwent right liver resection for primary liver cancer from January 2012 to January 2015 at Zhejiang Armed Police Hospital were randomly divided into an observation group and a control group, with 40 cases in each group. The observation group was given sevoflurane pretreatment. Serum levels of tumor necrosis factor-α (TNF-α), intestinal fatty acid binding protein (I-FABP), and D-lactate at different time points were compared between the two groups, and adverse reactions of the digestive system were recorded.

RESULTS: Serum TNF-α and D-lactate concentrations in both groups rose from before induction of anesthesia, peaked at 6 h after the release of the porta hepatis, and then declined. Serum TNF-α and D-lactate concentrations from the occlusion of the porta hepatis to 24 h after the release of the porta hepatis were significantly lower in the observation group than in the control group (P < 0.05). Serum I-FABP concentrations in both groups increased from the occlusion of the porta hepatis, peaked at 36 h after the release of the porta hepatis, and declined from 6 h. Serum I-FABP concentrations from the occlusion of the porta hepatis to 24 h after the release of the porta hepatis were significantly lower in the observation group than in the control group (P < 0.05).The incidence of adverse reactions of the digestive system was significantly lower in the observation group than in the control group (12.5% vs 27.5%, P < 0.05).

CONCLUSION: Sevoflurane preconditioning can suppress the body's inflammatory response, reduce the incidence of postoperative digestive system adverse reactions, and mitigate digestive system damage in patients with primary liver cancer undergoing surgery.