Department of Anesthesiology, School of Medicine, Keio University, Tokyo, Japan.
Department of Anesthesiology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro, Tokyo, 153-8515, Japan.
J Anesth. 2018 Aug;32(4):599-607. doi: 10.1007/s00540-018-2523-7. Epub 2018 Jun 21.
Both anesthetic-induced and ischemic preconditioning are protective against hepatic ischemia-reperfusion injury. However, the effects of these preventive methods on the metabolic function remain to be elucidated. We investigated the anesthetic conditioning and ischemic preconditioning on the metabolic function of the rabbit model of hepatic ischemia-reperfusion.
After approval by the institutional animal care and use committee, 36 Japanese White rabbits underwent partial hepatic ischemia for 90 min either under sevoflurane or propofol anesthesia. All the rabbits underwent 90 min of hepatic ischemia, and half of the rabbits in each group underwent additional 10-min ischemia and 10-min reperfusion before index ischemia. Hepatic microvascular blood flow was intermittently measured during reperfusion period, and galactose clearance, serum aminotransferase activities, and lactate concentrations were determined 180 min after reperfusion.
Neither anesthetic conditioning with sevoflurane nor ischemic preconditioning altered hepatic microvascular blood flow during reperfusion and serum transaminase activities after reperfusion. However, galactose clearance of reperfused liver was significantly higher under sevoflurane anesthesia than propofol (0.016 ± 0.005/min vs. 0.011 ± 0.004/min). Statistically significant interaction between anesthetic choice and application of ischemic preconditioning suggests that the ischemic preconditioning is selectively protective under propofol anesthesia. Increase of blood lactate concentration was significantly suppressed under sevoflurane anesthesia compared to propofol (1.5 ± 0.8 vs. 3.9 ± 1.4 mmol/l) without any statistically significant interaction with the application of ischemic preconditioning.
Sevoflurane attenuated the decrease of galactose clearance and increase of the blood lactate after reperfusion compared to propofol. Application of ischemic preconditioning was significantly protective under propofol anesthesia.
麻醉诱导和缺血预处理均能防止肝缺血再灌注损伤。然而，这些预防方法对代谢功能的影响仍有待阐明。我们研究了麻醉预处理和缺血预处理对兔肝缺血再灌注模型代谢功能的影响。
在机构动物护理和使用委员会批准后，36 只日本白兔在七氟醚或异丙酚麻醉下接受部分肝缺血 90 分钟。所有兔子都经历了 90 分钟的肝缺血，每组一半的兔子在指数性缺血前进行了额外的 10 分钟缺血和 10 分钟再灌注。在再灌注期间间歇性测量肝微血管血流，再灌注 180 分钟后测定半乳糖清除率、血清转氨酶活性和乳酸浓度。
七氟醚麻醉预处理或缺血预处理均未改变再灌注期间肝微血管血流和再灌注后血清转氨酶活性。然而，七氟醚麻醉下再灌注肝脏的半乳糖清除率明显高于异丙酚（0.016±0.005/min 比 0.011±0.004/min）。麻醉选择和缺血预处理应用之间存在显著的交互作用表明，缺血预处理在异丙酚麻醉下具有选择性保护作用。与异丙酚相比，七氟醚麻醉下的血乳酸浓度升高明显受到抑制（1.5±0.8 比 3.9±1.4mmol/l），与缺血预处理的应用无统计学显著交互作用。
与异丙酚相比，七氟醚可减轻再灌注后半乳糖清除率下降和血乳酸升高。在异丙酚麻醉下应用缺血预处理具有显著的保护作用。
