Carles M, Dellamonica J, Roux J, Lena D, Levraut J, Pittet J F, Boileau P, Raucoules-Aime M
Department of Anaesthesia and Intensive Care, Archet Hospital, University of Nice, 151 Route de St Antoine Ginestière, 06202 Nice, France.
Br J Anaesth. 2008 Jan;100(1):29-35. doi: 10.1093/bja/aem321. Epub 2007 Nov 20.
Ischaemia/reperfusion (I/R) is one of the main pathophysiological phenomena involved in the anaesthetic practice. The authors hypothesized that anaesthetic regimens can influence skeletal muscle tolerance to tourniquet-induced I/R that should be reflected by the interstitial metabolite levels of anaerobic glycolysis.
Microdialysis probes were implanted in three groups of 10 patients each receiving either sevoflurane (SEVO), propofol (PRO), or spinal (SA) anaesthesia (for induction and maintenance). SA group was considered as a control group. Interstitial fluid was obtained during tourniquet-induced I/R and was analysed for interstitial glucose, lactate, pyruvate, and glycerol.
The microdialysis flow rate was 0.5 microl min(-1). Compared with the control group, the SEVO group had a higher level of both lactate and pyruvate and an increase in glucose during ischaemia. In contrast, the PRO group had a lower level of pyruvate, resulting in a significant higher increase (eight times from baseline) of the lactate pyruvate ratio. Glucose level remained low in this group. During reperfusion, lactate, pyruvate, and glucose remained at a significantly higher level in the SEVO group. In the PRO group, there was no difference in lactate, pyruvate, and glucose levels compared with the control group. The interstitial level of glycerol exhibits only few and comparable changes during I/R between the groups.
Our results indicate that there is a better availability of interstitial glycolysis metabolites (glucose, lactate, and pyruvate) in the skeletal muscle during ischaemia and reperfusion after sevoflurane exposure than after propofol, suggesting a potential preconditioning effect of sevoflurane on tourniquet-induced skeletal muscle I/R.
缺血/再灌注（I/R）是麻醉实践中涉及的主要病理生理现象之一。作者推测麻醉方案可影响骨骼肌对止血带诱导的I/R的耐受性，这应通过无氧糖酵解的间质代谢物水平来反映。
将微透析探针植入三组患者，每组10例，分别接受七氟醚（SEVO）、丙泊酚（PRO）或脊髓麻醉（SA）（用于诱导和维持）。SA组被视为对照组。在止血带诱导的I/R期间获取间质液，并分析间质葡萄糖、乳酸、丙酮酸和甘油。
微透析流速为0.5微升/分钟（-1）。与对照组相比，SEVO组在缺血期间乳酸和丙酮酸水平较高，葡萄糖增加。相比之下，PRO组丙酮酸水平较低，导致乳酸/丙酮酸比值显著升高（较基线增加八倍）。该组葡萄糖水平保持较低。在再灌注期间，SEVO组的乳酸、丙酮酸和葡萄糖水平仍显著较高。在PRO组中，与对照组相比，乳酸、丙酮酸和葡萄糖水平没有差异。各组间在I/R期间甘油的间质水平仅表现出很少且相当的变化。
我们的结果表明，与丙泊酚暴露后相比，七氟醚暴露后在缺血和再灌注期间骨骼肌中间质糖酵解代谢物（葡萄糖、乳酸和丙酮酸）的可用性更好，提示七氟醚对止血带诱导的骨骼肌I/R具有潜在的预处理作用。
