Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, 37# Guoxue Xiang, Chengdu, 610041, Sichuan, China.
Department of Anesthesiology, West China Hospital of Sichuan University, 37# Guoxue Xiang, Chengdu, 610041, Sichuan, China.
BMC Anesthesiol. 2021 Mar 17;21(1):80. doi: 10.1186/s12871-021-01301-0.
Metabolic status can be impacted by general anesthesia and surgery. However, the exact effects of general anesthesia and surgery on systemic metabolome remain unclear, which might contribute to postoperative outcomes.
Five hundred patients who underwent abdominal surgery were included. General anesthesia was mainly maintained with sevoflurane. The end-tidal sevoflurane concentration (ET) was adjusted to maintain BIS (Bispectral index) value between 40 and 60. The mean ET from 20 min after endotracheal intubation to 2 h after the beginning of surgery was calculated for each patient. The patients were further divided into low ET group (mean - SD) and high ET group (mean + SD) to investigate the possible metabolic changes relevant to the amount of sevoflurane exposure.
The mean ET of the 500 patients was 1.60% ± 0.34%. Patients with low ET (n = 55) and high ET (n = 59) were selected for metabolomic analysis (1.06% ± 0.13% vs. 2.17% ± 0.16%, P < 0.001). Sevoflurane and abdominal surgery disturbed the tricarboxylic acid cycle as identified by increased citrate and cis-aconitate levels and impacted glycometabolism as identified by increased sucrose and D-glucose levels in these 114 patients. Glutamate metabolism was also impacted by sevoflurane and abdominal surgery in all the patients. In the patients with high ET, levels of L-glutamine, pyroglutamic acid, sphinganine and L-selenocysteine after sevoflurane anesthesia and abdominal surgery were significantly higher than those of the patients with low ET, suggesting that these metabolic changes might be relevant to the amount of sevoflurane exposure.
Sevoflurane anesthesia and abdominal surgery can impact principal metabolic pathways in clinical patients including tricarboxylic acid cycle, glycometabolism and glutamate metabolism. This study may provide a resource data for future studies about metabolism relevant to general anaesthesia and surgeries.
www.chictr.org.cn . identifier: ChiCTR1800014327 .
全身麻醉和手术会影响代谢状态。然而，全身麻醉和手术对系统代谢组的确切影响尚不清楚，这可能会影响术后结果。
纳入 500 例行腹部手术的患者。全身麻醉主要以七氟醚维持。调整呼气末七氟醚浓度（ET），使脑电双频指数（BIS）值维持在 40 至 60 之间。计算每位患者从气管插管后 20 分钟至手术开始后 2 小时的平均 ET。根据七氟醚暴露量，将患者进一步分为低 ET 组（均值-标准差）和高 ET 组（均值+标准差），以探讨与七氟醚暴露量相关的可能代谢变化。
500 例患者的平均 ET 为 1.60%±0.34%。选择低 ET（n=55）和高 ET（n=59）患者进行代谢组学分析（1.06%±0.13%比 2.17%±0.16%，P<0.001）。七氟醚和腹部手术扰乱了柠檬酸和顺式乌头酸水平升高所表明的三羧酸循环，还影响了蔗糖和 D-葡萄糖水平升高所表明的糖代谢，这在 114 例患者中得到证实。谷氨酸代谢也在所有患者中受到七氟醚和腹部手术的影响。在高 ET 患者中，七氟醚麻醉和腹部手术后 L-谷氨酰胺、焦谷氨酸、神经鞘氨醇和 L-硒代半胱氨酸的水平明显高于低 ET 患者，表明这些代谢变化可能与七氟醚暴露量有关。
七氟醚麻醉和腹部手术可影响包括三羧酸循环、糖代谢和谷氨酸代谢在内的临床患者的主要代谢途径。本研究可能为未来与全身麻醉和手术相关的代谢研究提供资源数据。
