Aslı DEMİR, Büşra TEZCAN, Bahar AYDINLI, Pınar ULUER DURAK, Sevil TOKAT, Mine TAŞLIPINAR, Mustafa ATABEY, Özcan ERDEMLİ

Short time antioxidant effect of sevoflurane and desflurane anesthesia, immediately before coronary artery bypass grafting

Amaç. Volatil anestezikler oksidan etkiyi zayıflatabilirler. Bu çalışmanın amacı koroner arterbypass greft ameliyatının hemen öncesinde malondialdehit (MDA), süperoksit dismutaz (SOD) veglutatyon peroksidaz (GPx) ile sevofluran ve desfluranın antioksidan etkisinin araştırılmasıdır.Yöntemler. Koroner arter baypas greft ameliyatı geçirecek 40 hasta çalışmaya alındı, hastalarrastgele 20şer kişilik iki gruba ayrıldı. Anestezi %40 oksijen ile hava karışımı yanında Grup Dde1MAC desfluran, Grup Sde 1MAC sevofluran ile sürdürüldü. MDA, SOD ve GPx için kanörnekleri; T1; anestezi indüksiyonundan önce (bazal), T2; cerrahi insizyondan önce (yaklaşıkT1den 20 dk sonra), T3; kardiyopulmoner baypastan önce (yaklaşık T2 den 60 dk sonra) alındı.Bulgular. Bazal değerlere göre her iki grupta MDA, SOD ve GPx değerleri T2 ve T3zamanlarında anlamlı artış gösterdi. Grup D için bu artış Grup Sden daha fazlaydı. Sonuç.Koroner arter baypas greft ameliyatının hemen öncesinde desfluran, sevoflurandan daha fazlasistemik lipid peroksidasyonuna neden olur sonucuna vardık.

Koroner arter baypas gref t öncesinde sevof luran ve desf luranın kısa süreli antioksidan etkileri

Aim. Volatile anesthetics may represent a choice to attenuate oxidant effects. The aim of this studyis to investigate the antioxidant status during sevoflurane and desflurane anesthesia immediatelybefore coronary artery bypass graft surgery (CABG) with malondialdehyde (MDA), superoxidedismutase (SOD) and gluthation peroxidase (GPx). Methods. Forty patients, undergoing coronaryartery bypass surgery, were enrolled in the study and randomized into two groups of 20 patientseach. Anesthesia was maintained with 40% oxygen in air mixture, 1 minimum alveolarconcentration (MAC) of desflurane in Group D and sevoflurane in Group S. Blood sampling forthe measurements of MDA, SOD and GPx were performed at, T1-before anesthesia induction(baseline), T2-before surgical incision (about 20 min after T1), T3-before cardiopulmonary bypass(about 60 min after T2). Results. Plasma concentrations of MDA, SOD and GPx levels increasedsignificantly during T2 and T3 periods as compared with the baseline values in both groups. Thisincrease was greater in group D versus group S. Conclusion. We conclude that desflurane maycause more systemic lipid peroxidation than sevoflurane during immediately before CABG.

PDF

___

1. Koksal GM, Sayılgan C, Aydın S, Uzun H, Oz H. The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy. Eur J Anaesthesiol 2004; 21: 217-20.
2. Hanley PJ, Ray J, Brandt U, Daut J. Halothane, isoflurane and sevoflurane inhibit NADH:ubiquinone oxidoreductase (complex I) of cardiac mitochondria. J Physiol 2002; 544: 687-93.
3. Pechan I, Olejarova I, Danova K, Fischer V, Minarova H, Dobisova A, Halcak L, Rendekova V, Gabauer I. Antioxidant status of patients after on-pump and off- pump coronary artery bypass grafting. Bratisl Lek Listy 2004; 105: 45-50.
4. Dikmen B, Unal Y, Pampal HK, Nurlu N, Kurtipek O, Canbolat O, Ozoğul C, Kavutcu M. Effects of repeated desflurane and sevoflurane anesthesia on enzymatic free radical scavanger system. Mol Cell Biochem 2007; 294: 31-6.
5. Hu G, Vasiliauskas T, Salem MR, Rhone DP, Crystal GJ. Neutrophils pretreated with volatile anesthetics lose ability to cause cardiac dysfunction. Anesthesiology 2003; 98: 712-8.
6. Turan R, Yagmurdur H, Kavutcu M, Dikmen B. Propofol and tourniquet induced ischaemia reperfusion injury in lower extremity operations. Eur J Anaesthesiol 2007; 24: 185-9.
7. Yoshioka T, Kawada K, Shimada T, Mori M. Lipid peroxidation in maternal and cord blood and protective mechanism against activated-oxygen toxicity in the blood. Am J Obstet Gynecol 1979; 135: 372-6.
8. Sun Y, Oberley LW, Li Y. A simple method for clinical assay of superoxide dismutase. Clin Chem 1988; 34: 497-500.
9. Paglia DE, Valentine WN. Studies on the quantitative and qualitative characterization of erythrocyte glutathione peroxidase. J Lab Clin Med 1967; 70: 158-69.
10. Ochoa JJ, Vilchez MJ, Mataix J, Ibáñez-Quiles S, Palacios MA, Muñoz-Hoyos A. Oxidative stress in patients undergoing cardiac surgery: comparative study of revascularization and valve replacement procedures. J Surg Res 2003; 111: 248- 54.
11. Kevin LG, Novalija E, Stowe DF. Reactive oxygen species as mediators of cardiac injury and protection: The relevance to anesthesia practice. Anesth Analg 2005; 101: 1275-87.
12. Belhomme D, Peynet J, Louzy M, Launay JM, Kitakaze M, Menasché P. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation 1999; 100: II340-4.
13. Gönenç A, Hacişevki A, Bakkaloğlu B, Soyağir A, Torun M, Karagöz H, Simşek B. Oxidative stress is decreased in off-pump versus on-pump coronary artery surgery. J Biochem Mol Biol 2006; 39: 377-82.
14. Sivaci R, Kahraman A, Serteser M, Sahin DA, Dilek ON. Cytotoxic effects of volatile anesthetics with free radicals undergoing laparoscopic surgery. Clin Biochem 2006; 39: 293-8.