Protective Effect of Sevoflurane Preconditioning on Ischemia-reperfusion Injury in Patients Undergoing Reconstructive Plastic Surgery with Microsurgical Flap, a Randomized Controlled Trial

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2016 Aug 24

PMID 27549313

Citations 7

Authors

Claudia Claroni

Giulia Torregiani

Marco Covotta

Maria Sofra

Alessandra Scotto di Uccio

Maria E Marcelli

Alessia Naccarato

Ester Forastiere

Affiliations

Soon will be listed here.

Abstract

Background: In many clinical conditions that involve free flaps and tissue transplantations the possibility of minimizing ischemia-reperfusion injury can be a determinant factor for the success of the surgery itself. We hypothesize that preconditioning with sevoflurane is a protective factor against ischemia-reperfusion injury.

Methods: In this randomized controlled trial, patients ASA I-II undergoing breast reconstruction with deep inferior epigastric perforator flaps were allocated into two groups and analyzed: group BAL included patients who received balanced anesthesia with sevoflurane for 30 min before removal of the flap and throughout the surgery. The TCI group included patients who received a total intravenous anesthesia with propofol and remifentanil. We evaluated regional tissue oximetry at the end of the surgery and at 4, 12 and 20 h after surgery. Other assessed parameters were: blood lactate clearance, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, creatine phosphokinase.

Results: In total 54 patients, twenty-seven per group, were analyzed. There was a significant increase of the average value of regional tissue oximetry measured 4 h after surgery in the BAL group compared to the TCI group: BAL: 84.05 % (8.96 SD); TCI : 76.17 % (12.92 SD) (P = 0.03), but not at the other time frames. The creatine phosphokinase value was significantly lower in the BAL group at the end of surgery, but not at the other time-frames. There were no significant differences in blood levels of other markers.

Conclusions: From our results, the positive preconditioning impact of sevoflurane on ischemia-reperfusion injury in patients undergoing free flap surgery is expressed in the early postoperative hours, but it does not persist in the long-term.

Trial Registration: ClinicalTrial.gov identifier: NCT01905501 . Registered July 18, 2013.

Citing Articles

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Goswami U, Jain A J Anaesthesiol Clin Pharmacol. 2022; 37(4):499-504.

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Propofol-based total intravenous anesthesia decreases the incidence of postoperative nausea and vomiting without affecting flap survival in free flap breast reconstruction.

Yang L, Xu Y, Shen J, Lou F, Zhang J, Wu J Gland Surg. 2020; 9(5):1406-1414.

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Ma X, Ouyang Y, Li C, Du X, Liu C Breast. 2020; 52:150.

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Sevoflurane Pre-conditioning Ameliorates Diabetic Myocardial Ischemia/Reperfusion Injury Via Differential Regulation of p38 and ERK.

Xie D, Zhao J, Guo R, Jiao L, Zhang Y, Lau W Sci Rep. 2020; 10(1):23.

PMID: 31913350 PMC: 6949279. DOI: 10.1038/s41598-019-56897-8.

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