The effects of etomidate, thiopental, and propofol in induction on hypoperfusion-reperfusion phenomenon during laparoscopic cholecystectomy

A mini-review of the effects of inhalational and intravenous anesthetics on oxidative stress in dogs

General anesthesia increases the production of reactive oxygen species (ROS), which can exacerbate or increase oxidative stress and thus affect the prognosis of surgical procedures. Oxidative stress has been implicated in the development of cardiovascular, dermatologic, oncologic, and other diseases in dogs, as well as ischemia and reperfusion injury. Some anesthetics, such as halogenated anesthetics, have been shown to stimulate the production of ROS, while others, such as propofol, have antioxidant properties. However, the antioxidant effects of these anesthetics may not be sufficient to counteract oxidative damage at the doses used clinically. Nevertheless, the effects of anesthetics should be considered to minimize oxidative damage during anesthesia in dogs to improve the outcome of procedures requiring general anesthesia. This mini-review addresses the current knowledge on oxidative stress during inhalational and intravenous anesthesia in dogs. There is still a lack of information on the management of anesthesia in dogs with respect to oxidative stress. Further research, including comprehensive clinical studies is needed to better understand oxidative injury mechanisms and improve perioperative protocols during anesthesia in dogs.

Oxidative stress under general intravenous and inhalation anaesthesia

Oxidative stress occurs when reactive oxygen species (ROS) production overwhelms cell protection by antioxidants. This review is focused on general anaesthesia-induced oxidative stress because it increases the rate of complications and delays recovery after surgery. It is important to know what effects of anaesthetics to expect in terms of oxidative stress, particularly in surgical procedures with high ROS production, because their either additive or antagonistic effect may be pivotal for the outcome of surgery. In vitro and animal studies on this topic are numerous but show large variability. There are not many human studies and what we know has been learned from different surgical procedures measuring different endpoints in blood samples taken mostly before and after surgery. In these studies most intravenous anaesthetics have antioxidative properties, while volatile anaesthetics temporarily increase oxidative stress in longer surgical procedures.

The comparison of the effects of ketamine and etomidate on cardiodynamics, biochemical and oxidative stress parameters in Wistar male rats

It is well known the use of ketamine and etomidate in clinical practice; however, the difference in the systemic effects of these two anesthetic agents is still debatable. Thus, in the present study we aimed to compare their effects on heart, and other organs through estimation of cardiodynamics, biochemical and hematological parameters. Male Wistar rats were divided in 2 groups containing of 2 subgroups (n = 7 in each subgroup, n = 28 in total): (1) bolus injection of anesthetic ketamine (40 mg/kg b.w., i.p. n = 14); (2) bolus injection of anesthetic etomidate (20 mg/kg b.w., i.p. n = 14). The experiments were done in vitro in one subgroup of each group: cardiodynamic variables (dp/dt_max, dp/dt_min, heart rate), coronary flow, oxidative stress in coronary effluent and cardiac tissue homogenate, and in vivo in another subgroup: biochemical and hematological parameters, and oxidative stress in haemolysate. Significantly increased left ventricular contractility (dp/dt_max) and relaxation (dp/dt_min) were noticed in etomidate group. Creatinine (CREA), HDL cholesterol and folate were significantly higher in etomidate group, whereas amylase (AMY) and eosinophils in ketamine group. Our results suggested that ketamine has more antioxidant potential compared to etomidate, and etomidate has more favorable effects regarding cardiac performance.

[Effects of various anesthesia maintenance on serum levels of selenium, copper, zinc, iron and antioxidant capacity]

BACKGROUND AND OBJECTIVES

In this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity.

METHODS

60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5mgkg(-1) propofol, 1mgkg(-1) lidocaine and 0.6mgkg(-1) rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4Lmin(-1), 1 MAC sevoflorane was administered to Group S and 1 MAC desflurane to Group D; and under carrier gas of 50:50% O2:air 4Lmin(-1) 6mgkgh(-1) propofol and 1μgkgh(-1) fentanyl infusion were administered to Group P. At postoperative blood specimens were collected again.

RESULTS

It was observed that only in Group S and P, levels of MDA decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in Group S and Group P, zinc levels decreased in Group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period.

CONCLUSION

According to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system.

Propofol participates in gastric mucosal protection through inhibiting the toll-like receptor-4/nuclear factor kappa-B signaling pathway

AIMS

Propofol has demonstrated protective effects against digestive injury. Toll-like receptor-4 (TLR4) is involved in gastric mucosal injury. However, it has not yet been clarified whether propofol protects gastric mucosa from ethanol-induced injury and whether the mechanism involved is related to TLR4 activation. Therefore, this prospective study was carried out to address the issue.

METHODS

Gastric mucosal injury was induced in mice by intragastric administration of ethanol. Propofol was given intraperitoneally 30 min before ethanol intragastric administration and, 1h later, gastric specimens were studied using hematoxylin--eosin staining, quantitative real-time RT-PCR, immunohistochemical staining and Western blot assays; serum specimens were studied using ELISA kits.

RESULTS

Propofol at 25mg/kg significantly attenuated ethanol-induced gastric mucosal injury. In addition, propofol pretreatment significantly inhibited the upregulated expression of high-mobility group box-1 (HMGB1) protein, TLR4 and its downstream signaling molecules--myeloid differentiation factor 88 (MyD88) and nuclear factor kappa-B (NF-κB)--in gastric mucosa, while suppressing the increased release of tumor neurosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serum. Furthermore, upregulation of the Bax/Bcl-2 ratio in gastric mucosa was clearly depressed by propofol.

CONCLUSION

Propofol can inhibit HMGB1 expression and TLR4/MyD88/NF-κB-mediated inflammatory responses, and hamper apoptosis, which may contribute to its protective action against ethanol-induced gastric mucosal injury.

Oxidative stress response after laparoscopic versus conventional sigmoid resection: a randomized, double-blind clinical trial

Surgery is accompanied by a surgical stress response, which results in increased morbidity and mortality. Oxidative stress is a part of the surgical stress response. Minimally invasive laparoscopic surgery may result in reduced oxidative stress compared with open surgery. Nineteen patients scheduled for sigmoid resection were randomly allocated to open or laparoscopic sigmoid resection in a double-blind, prospective clinical trial. Three biochemical markers of oxidative stress (malondialdehyde, ascorbic acid, and dehydroascorbic acid) were measured at 6 different time points (preoperatively, 1 h, 6 h, 24 h, 48 h, and 72 h postoperatively). There were no statistical significant differences between laparoscopic and open surgery for any of the 3 oxidative stress parameters. Malondialdehyde was reduced 1 hour postoperatively (P<0.001) for all 19 patients. There was a significant drop in ascorbic acid at 1 hour and 6 hours after the first abdominal incision (P=0.002) for all 19 patients. Laparoscopic surgery was not found to be associated with reduced oxidative stress.

Pharmacological modulation of oxidative stress response in minimally invasive surgery: systematic review

This systematic review aims to synthesize the data on the effectiveness of pharmacological modulation of stress response in minimally invasive surgery. Eligible trials were clinical trials randomized or not or experimental trials that investigated the effect of pharmacological agents on modulation of surgical stress response to minimally invasive surgery. No clinical trials were identified. Eight experimental trials met the inclusion criteria and were obtained in full text. Experimental models were rats or rabbits subjected to pneumoperitoneum, or pneumoretroperitoneum, not to a whole operation. Pharmacological modulation of surgical stress response was attempted with erythromycin, melatonin, mesna, verapamil, pentoxifylline, N-acetylcysteine, and zinc. All the pharmacological agents, except pentoxifylline, seemed to reduce oxidative stress markers. However, only mesna pretreatment prevented oxidative stress, because oxidative stress markers remained in the sham levels. Contrasting data were obtained for pentoxyphilline. In conclusion, available data suggest that pharmacological modulation of surgical stress response to minimally invasive surgery might be feasible.

Increased oxidative stress and gut ischemia caused by prolonged pneumoperitoneum in patients undergoing robot-assisted laparoscopic radical prostatectomy

OBJECTIVE

To investigate changes in plasma oxidative stress markers associated with prolonged pneumoperitoneum during robot-assisted laparoscopic radical prostatectomy (RALP).

METHODS

In all, patients of ASA Physical Status II-III who intended to undergo RALP were enrolled in the study. Arterial plasma levels of malondialdehyde (MDA) and intramucosal pH were measured 1 minute before and at 1 hour, 2 hours, 3 hours, and 4 hours after the introduction of pneumoperitoneum at an insufflation pressure of 15 mmHg; likewise, they were again measured every 10 minutes after deflation for 60 minutes, at 2 hours and 12 hours after deflation.

RESULTS

The mean duration of pneumoperitoneum was around 4 hours. After induction of pneumoperitoneum, the MDA concentrations were significantly elevated at various time points as compared with the preinsufflation value. Significant increase of MDA value was noted also 30 minutes after deflation as compared with the pre-deflation levels. The intramucosal pH value decreased significantly after CO(2) insufflation compared with the preinsufflation values. It also increased significantly 2 hours after CO(2) deflation as compared with the pre-deflation values.

CONCLUSION

A prolonged pneumoperitoneum in RALP results in decreased splanchnic blood flow. Pneumoperitoneum itself produces oxidative stress, and ischemia-reperfusion model after deflation of pneumoperitoneum produces more oxidative stress.

Effect of an anesthesia with propofol compared with desflurane on free radical production and liver function after partial hepatectomy

Propofol has shown antioxidant properties, but no study has focused on liver resection surgery. The aim of this study was to investigate the effect of an anesthesia with propofol compared with desflurane on oxidative stress and hepatic function during and after partial hepatectomy. This was a prospective randomized study performed on two parallel groups. The primary endpoint was malondialdehyde (MDA) plasma concentration 30 min after hepatic vascular unclamping. Hepatic damages were evaluated by plasma levels of alpha-glutathione S-transferase (α-GST) 120 min after hepatic vascular unclamping and of aminotransferases at 120 min and on days 1, 2, 5, and 10. Liver function recovery was assessed by monoethylglycinexylidide (MEGX) formation 15 min after lidocaine injection on day 2 and by prothrombin time and plasma factor V at 120 min and on days 1, 2, 5, and 10. Thirty patients were analyzed (propofol group: 17; desflurane group: 13). There was no significant difference between groups for MDA plasma concentration 30 min after hepatic vascular unclamping (mean ± standard-deviation: 1.28 ± 0.40 and 1.21 ± 0.29 in propofol and desflurane groups, respectively, P = 0.608). Plasma levels of α-GST at 120 min were lower in propofol than in desflurane group (142.2 ± 75.4 vs. 205.7 ± 66.5, P = 0.023), and MEGX on day 2 was higher (0.092 ± 0.096 vs. 0.036 ± 0.020, P = 0.007). No differences between groups were observed with regard to plasma levels of aminotransferases, prothrombin time, and plasma factor V. Our study showed that in patients undergoing partial hepatectomy, propofol did not reduce MDA formation but seemed to display a protective effect on hepatic damages and liver function when compared to desflurane.

Effects of vitamin C and E combination on element and oxidative stress levels in the blood of operative patients under desflurane anesthesia

We investigated effects of vitamin C and E (VCE) administration on desflurane-induced oxidative toxicity and element changes in the blood of operative patients under desflurane general anesthesia. Forty American Society of Anesthesiologists I or II Physical Status adult patients were scheduled for elective surgery. The patients were randomly divided into two groups. Control and VCE group was introduced to anesthesia with desflurane. VCE was administreted to patients in the control and VCE group before 1 hour of anesthesia with desflurane. Baseline (preoperative) and postoperative (at the 1(st), the 24(th), and 72(th) h), blood samples were taken from the first and second groups. Erythrocyte and plasma lipid peroxidation levels at the 1(st), 24(th), and 72(th) hours were higher in the control than in baseline group, although their levels at the same periods were lower in the VCE group than in the control. Vitamin E levels at the postoperative 1(st) and 24(th) hours and erythrocyte glutathione peroxidase (GSH-Px) activity at the postoperative 1(st), 24(th), and 72(th) hours was lower than in baseline values. Erythrocyte GSH-Px activity and plasma vitamins A, C, and E levels at the postoperative 1(st), 24(th), and 72(th) hours were higher in the VCE group than in the control group. Erythrocyte and plasma reduced glutathione, plasma β-carotene, and serum copper, while zinc, selenium, aluminum, iron, magnesium, and calcium levels did not differ between preoperative and postoperative periods in both groups. In conclusion, VCE combination prevented the desflurane-induced vitamin E and GSH-Px consumptions to strengthen the antioxidant levels in the blood of operative patients.

No effect of melatonin on oxidative stress after laparoscopic cholecystectomy: a randomized placebo-controlled trial

BACKGROUND

Melatonin, an endogenous circadian regulator, also has antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the antioxidative effect of melatonin in patients undergoing laparoscopic cholecystectomy.

METHODS

Patients were randomized to receive 10 mg melatonin or placebo during surgery. Blood samples for analysis of malondialdehyde (MDA), ascorbic acid (AA), total ascorbic acid (TAA) dehydroascorbic acid (DHA) and C-reactive protein (CRP) were collected pre-operatively and at 5 min, 6 h and 24 h after operation.

RESULTS

Twenty patients received melatonin and 21 patients received placebo during surgery. No significant differences were observed between the groups in the oxidative stress variables MDA, TAA, AA and DHA or in the inflammatory variable CRP (repeated-measures ANOVA, P>0.05 for all variables).

CONCLUSIONS

Administration of 10 mg melatonin did not reduce variables of oxidative stress in patients undergoing elective laparoscopic cholecystectomy.

Protective effects of propofol against ischemia/reperfusion injury in rat kidneys

AIM

The purpose of this study was to investigate and compare the efficiency of propofol in the reduction of injury induced by free radicals in a rat model of renal ischemia/reperfusion (I/R).

METHOD

Twenty-four Wistar rats were divided into four groups in our study. Rats in the sham group underwent laparotomy and were made to wait for 120 min without ischemia. Rats in the control group were given nothing with ischemia-reperfusion. Rats in the I/R groups were given propofol (25 mg/kg) and 10% intralipid (250 mg/kg) ip, respectively, 15 min before the ischemia for 60 min followed by reperfusion for 60 min. The kidney tissues of the rats were taken under anesthesia at the end of the reperfusion period. Evaluation of biochemical malondialdehyde (MDA), superoxide dismutase, and catalase activities and histopathological analysis were performed with these samples.

RESULTS

I/R significantly increased MDA levels (p < 0.05). Histopathological findings of the control group confirmed that there was renal impairment by tubular cell swelling, interstitial edema, medullary congestion, and tubular dilatation. MDA levels were lower in the propofol group compared to control group (p < 0.05). In the propofol group, the level of histopathological scores is significantly decreased than control and intralipid groups in ischemia-reperfusion.

CONCLUSION

Our results demonstrate that I/R injury was significantly reduced in the presence of propofol. The protective effects of propofol may be due to their antioxidant properties. These results may indicate that propofol anesthesia protects against functional, biochemical, and morphological damage better than control in renal I/R injury.

Thiopental improves renal ischemia-reperfusion injury

Ischemia/reperfusion (I/R) occurs in a number of pathological conditions, including myocardial infarction, stroke, aortic surgery, cardiopulmonary bypass surgery, organ transplantation, resuscitation, and critical care. Massive and abrupt release of oxygen-free radicals after reperfusion triggers oxidative damage. Before critical operations or after resuscitation, it would be wise to find a suitable prophylactic treatment to avoid I/R damage. We aimed to determine whether several commonly used intravenous anesthetics protect against renal I/R injury.

METHODS

Animals were randomly divided into seven groups, each consisting of six animals: sham group, control group, thiopental group, propofol group, intralipid group, etomidate group, and ketamine group. At the end of the 60-min ischemic period, 60 min reperfusion was established and the materials administered 15 min before the reperfusion. At the end of the reperfusion period, the samples of blood and tissue were reaped for biochemical and serological evaluation.

RESULTS

I/R procedure significantly increased malondialdehyde (MDA) levels, decreased catalase (CAT) activities, and superoxide dismutase (SOD) levels. The lowest MDA mean level was in the thiopental group and the highest MDA mean level was in control group. The lowest CAT mean level was in the intralipid group and the highest CAT mean level was in the etomidate group. The lowest SOD mean level was in the control group and the highest SOD mean level was in the propofol group.

CONCLUSION

Thiopental and propofol, especially thiopental, are more effective to protect renal I/R injury.

Effects of propofol and etomidate on hydrogen peroxide-induced oxidative damage in hepatocyte

BACKGROUND

The present investigation was undertaken to evaluate the protective effect of propofol and etomidate against hydrogen peroxide (H2O2) induced oxidative damage in human hepatic SNU761 cells by measuring lactate dehydrogenase (LDH).

METHODS

The cell line of human hepatocellular carcinoma was grown for 24 hours in dissociated cell culture. They were divided into eight groups: negative control (NC) group with no drug administration, positive control (PC) group with H2O2 250 micrometer and other groups pretreated with propofol (P; 1, 10, 50 micrometer) or etomidate (ET; 1, 10, 50 micrometer) followed H2O2 administration. After 7 hours, cell death was assessed by morphology under the light microscope and quantified by measuring the LDH in the culture media.

RESULTS

In the light microscopic findings, the intact cells were increased in all three propofol groups compared to group PC. H2O2-induced LDH production was also significantly suppressed in all three propofol groups compared to group PC (P < 0.001). There were no significant differences in the microscopic findings and LDH production between the etomidate groups and group PC.

CONCLUSIONS

These results suggest that the propofol has protective effect on the hepatocyte against H2O2-induced oxidative stress.

Propofol reduces nitric oxide-induced apoptosis in testicular ischemia-reperfusion injury by downregulating the expression of inducible nitric oxide synthase

BACKGROUND

The aim of the present study was to investigate the underlying mechanisms in the preventive effects of intravenous anesthetics on testicular ischemia-reperfusion injury.

METHODS

Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) for 1 h and reperfusion (detorsion) for 24 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At 24 h of reperfusion, animals were killed and ipsilateral testes were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1).

RESULTS

Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were markedly increased in group 2, but these parameters were at the mild to moderate level in group 4 at 24 h of reperfusion. Also, elevated expression of iNOS was accompanied by a high NO production in group 2 compared with group 4. Although eNOS expressions were increased in both the groups (groups 2 and 4), there were no significant differences between these groups.

CONCLUSIONS

Propofol as an anesthetic agent may attenuate germ cell-specific apoptosis and decrease NO biosynthases through downregulation of iNOS expression in an animal model of testicular torsion and detorsion.

The protective effects of intravenous anesthetics and verapamil in gut ischemia/reperfusion-induced liver injury

BACKGROUND

We investigated the protective effects of IV anesthetics and verapamil in gut ischemia/reperfusion-induced liver injury.

METHODS

Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with propofol in Groups 1 and 3 and with thiopental in Groups 2 and 4 during the experiment. All animals developed intestinal ischemia after occlusion of the superior mesenteric artery for 30 min. Reperfusion was induced by removal of the microvascular clamp and was allowed to continue for 120 min. The animals in Groups 3 and 4 were given verapamil 10 min before reperfusion. Liver and ileum samples were taken for measurement of malondialdehyde (MDA) and histopathologic examination before ischemia and 30 and 120 min after reperfusion. Blood samples were also obtained for measurement of plasma tumor necrosis factor-alpha and interleukin-6 levels.

RESULTS

Gut ischemia/reperfusion-induced significant increases in MDA contents of liver and gut and serum cytokines, consistent with histopathologic injury scores. Propofol effectively stabilized the MDA levels and decreased the tissue injury scores of the liver and gut. Tumor necrosis factor-alpha and interleukin-6 levels increased less in the propofol groups than in the thiopental groups. There was no additive preventive effect of verapamil on propofol. The addition of verapamil to thiopental was effective in decreasing the serum cytokines and liver MDA content.

CONCLUSION

Propofol may offer advantages by inhibiting lipid peroxidation and inflammatory cytokine production in an animal model of gut ischemia/reperfusion-induced liver injury.

The preventive effects of thiopental and propofol on testicular ischemia-reperfusion injury

BACKGROUND

Testicular torsion is a urological emergency that requires immediate surgical intervention to prevent testicular damage. The aim of the study was to investigate the preventive effects of thiopental and propofol as anesthetics on testicular ischemia-reperfusion injury.

METHODS

Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. During 5 h, anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) during 1 h and reperfusion (detorsion) during 4 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At the end of 5 h, animals were killed and both ipsilateral and contralateral testes were removed for histopathologic examination and measurement of tissue MDA (malondialdehyde) and NO (nitric oxide) levels.

RESULTS

In the contralateral testes of all the groups, MDA and NO measurements were not different from ipsilateral testes of the control groups. Between the groups 1 and 3, there were no differences in MDA and NO levels. Although torsion/detorsion of testes in group 4 caused significantly increased levels of tissue MDA and NO values compared with group 3, ischemia-reperfusion in group 2 caused a further increase in these levels compared with group 4. The ipsilateral testes in the control groups did not show any morphological changes. Testicular torsion/detorsion in rats with thiopental anesthesia (group 2) caused significantly greater histopathologic injury levels than rats with propofol anesthesia (group 4).

CONCLUSION

Our results suggest that propofol as an anesthetic agent may prevent testicular damage by scavenging reactive oxygen and nitrogen species and inhibiting lipid peroxidation in an animal model of testicular torsion and detorsion.

The effects of propofol and ketamine on gut mucosal epithelial apoptosis in rats after burn injury

BACKGROUND AND OBJECTIVES

Apoptosis occurs after thermal injury and may result from either ischaemic intestinal insult or inflammatory mediators released after burn injury. The aim of the study was to investigate the effects of propofol and ketamine on gut epithelium apoptosis after burn injury.

METHODS

Sixty male Wistar Albino rats were randomly assigned into four groups. Anaesthesia was induced and maintained with propofol in Groups 1 and 2, and ketamine in Groups 3 and 4 over 12 h. Groups 2 and 4 received 30% total body surface area burn. Groups 1 and 3 had no burn injury. Mean arterial pressure was maintained within 10% of baseline levels in all animals. At 12 h postburn, animals were sacrificed and tissue samples were taken from small intestine for determination of lipid peroxidation, apoptosis and proliferation. Also blood samples were taken for measurement of serum tumor necrosis factor-alpha (TNF-alpha) levels.

RESULTS

Ileal malondialdehyde (MDA) concentration (extent of lipid peroxidation) increased significantly in Group 4 (112.4 +/- 10.2 nmol g-1) compared to Group 3 (48.4 +/- 5.6 nmol g-1) and Group 2 (59.8 +/- 3.2 nmol g-1). The mean TNF-alpha level in Group 4 (118.9 +/- 10.5 pg mL-1) at 12 h postburn was significantly higher than the mean in Group 2 (56.4 +/- 4.3 pg mL-1). Group 4 had the highest mean TUNEL index (terminal deoxyuridine nick-end labelling--an index of extent of apoptosis) of all the groups (265/10). Also the mean TUNEL index value in Group 2 (53/10) was higher than that of Group 1 (3/10) and Group 3 (5/10). The proliferating cell nuclear antigen index (extent of proliferation) remained unchanged among groups.

CONCLUSIONS

Propofol could offer a protection against apoptosis of enterocytes with a stable tissue MDA and serum TNF-alpha level compared to ketamine anaesthesia in an animal model of burn injury.

Cytotoxic effects of volatile anesthetics with free radicals undergoing laparoscopic surgery

BACKGROUND

Free radicals induced by several diseases can trigger oxidative stress, leading to the production of malondialdehyde (MDA) and protein carbonyl content (CB). Volatile agents are able to increase the extent of oxidative status. However, the effects of these agents together with pneumoperitonium (Pp) have not been reported. We aimed to investigate the role of volatile anesthetics and ischemic injury during Pp on free radicals and scavenging enzymes in laparoscopic abdominal surgery.

METHODS AND MATERIALS

Forty patients were examined. Patients were randomly divided into four groups in order to receive sevoflurane-fentanyl (SF = 10), sevoflurane-N(2)O (SN = 10), desflurane-fentanyl (DF = 10), and desflurane-N(2)O (DN = 10), respectively. Tidal volume and ventilation frequency were kept unchanged during the operation. Intraabdominal pressure was remained constant at 12 mm Hg. Baseline values in venous blood samples were preoperatively taken and blood was also taken postoperatively at the 6th and the 24th hours. After collection of blood samples into citrate (3.5 mg/mL blood) containing glass tubes, erythrocyte sediments were prepared for the analyses. Then malondialdehyde levels, protein carbonyl content, and sulfhydryl (SH) groups were measured.

RESULTS

The levels of MDA and protein carbonyl content were significantly higher at the 6th hour rather than the 24th hour postoperatively with desflurane anesthesia. In addition, SH groups were significantly different between the 6th hour and the 24th hour measurements (P < 0.05). In our study, desflurane caused a statistically significant increase in MDA levels and protein carbonyl content and a decrease in SH groups. When the two groups were compared, in the case of MDA and CB values, a significant increase was observed in the 6th and the 24th hour, where there was a decrease in SH groups in the desflurane group (P < 0.05). These parameters did not change in the sevoflurane group (P > 0.05).

CONCLUSION

We concluded that desflurane was affected by desflurane with low flow anesthesia in patients undergoing laparoscopic abdominal surgery. Significant influence on oxidative stress and antioxidant mechanics was not seen with sevoflurane anesthesia. Our studies support that oxidant and antioxidant defense mechanisms were altered in the desflurane group and this alteration improved after a combination of desflurane-N(2)O.