Department of Anaesthesiology, Division of Gastrointestinal Sciences, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.
The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.
Ann Card Anaesth. 2021 Jul-Sep;24(3):319-326. doi: 10.4103/aca.ACA_130_20.
Myocardial preconditioning using volatile anesthetics such as isoflurane and sevoflurane have beneficial effects in decreasing morbidity in cardiac surgical patients. Studies in animal models have indicated that reactive oxygen and nitrogen species probably play a role in mediating these effects. However, data from human studies are scarce and the differential effect of sevoflurane vs. isoflurane on reactive oxygen species (ROS) and reactive nitrogen species (RNS) has not been studied extensively.
Randomized clinical control trial comparing preconditioning effects of volatile agents isoflurane and sevoflurane when administered during coronary artery bypass surgeries on cardiopulmonary bypass (CPB). Serum samples were collected at 3 time points before induction, after cross clamp release and one hour after separation from CPB. Levels of oxidative stress markers and nitric oxide were analyzed in these samples.
Hemodynamic indices, cardio-pulmonary bypass duration, and ICU stay were similar between the groups. CKMB values 12 hours post-op were decreased in majority of patients in the sevoflurane group compared to isoflurane. Serum malondialdehyde and nitrate levels were lower with sevoflurane (P < 0.05) when compared to the isoflurane group, but no significant differences in protein carbonyl content or protein thiol content were evident between the 2 groups. Sevoflurane also prevented the decrease in total thiols during later stages of surgery.
Volatile anesthetics, isoflurane and sevoflurane modulate oxidative and nitrosative stress during CABG. Between the two pre-conditioning agents, isoflurane seems to provide better protection during the pre-bypass period, while sevoflurane provides protection during both pre- as well as post-bypass period.
使用挥发性麻醉剂（如异氟烷和七氟烷）进行心肌预处理可降低心脏手术患者的发病率。动物模型研究表明，活性氧和氮物种可能在介导这些作用中起作用。然而，来自人体研究的数据很少，并且尚未广泛研究七氟烷与异氟烷对活性氧（ROS）和活性氮（RNS）的差异影响。
比较了在体外循环（CPB）期间给予冠状动脉旁路手术的挥发性麻醉剂异氟烷和七氟烷预处理效果的随机临床试验。在诱导前、交叉夹释放后和从 CPB 分离后 1 小时收集 3 个时间点的血清样本。分析这些样本中的氧化应激标志物和一氧化氮水平。
两组之间的血流动力学指数、心肺转流时间和 ICU 停留时间相似。与异氟烷组相比，七氟烷组大多数患者术后 12 小时 CKMB 值降低。与异氟烷组相比，七氟烷组血清丙二醛和硝酸盐水平较低（P <0.05），但两组间蛋白质羰基含量或蛋白质巯基含量无明显差异。七氟烷还可防止手术后期总巯基的减少。
挥发性麻醉剂异氟烷和七氟烷可调节 CABG 期间的氧化和硝化应激。在两种预处理剂中，异氟烷似乎在旁路前期间提供更好的保护，而七氟烷在旁路前和后期间都提供保护。
