Article: Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients
| Title | Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients | ||||||
|---|---|---|---|---|---|---|---|
| Authors | Huang, Z1 2 5 Zhong, X4 Irwin, MG2 Ji, S5 Wong, GTC2 Liu, Y2 Xia, ZY1 Finegan, BA3 Xia, Z1 2 | ||||||
| Issue Date | 2011 | ||||||
| Publisher | Portland Press Ltd. The Journal's web site is located at http://www.clinsci.org/ | ||||||
| Citation | Clinical Science, 2011, v. 121 n. 2, p. 57-69 [How to Cite?] DOI: http://dx.doi.org/10.1042/CS20100435 | ||||||
| Abstract | Either isoflurane preconditioning or high-dose propofol treatment has been shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in patients undergoing CABG (coronary artery bypass graft) surgery. It is unknown whether isoflurane and propofol may synergistically attenuate myocardial injury in patients. The present study investigated the efficacy of IsoPC (isoflurane preconditioning), propofol treatment (postconditioning) and their synergy in attenuating postischaemic myocardial injury in patients undergoing CABG surgery using CPB (cardiopulmonary bypass). Patients (n = 120) selected for CABG surgery were randomly assigned to one of four groups (n = 30 each). After induction, anaesthesia was maintained either with fentanyl and midazolam (control; group C); with propofol at 100 mug x kg(-1) of body weight x min(-1) before and during CPB followed by propofol at 60 mug x kg(-1) of body weight x min(-1) for 15 min after aortic declamping (group P); with isoflurane 1-1.5% end tidal throughout the surgery (group I) or with isoflurane 1-1.5% end tidal before CPB and switching to propofol at 100 mug x kg(-1) of body weight x min(-1) during CPB followed by propofol at 60 mug x kg(-1) of body weight x min(-1) for 15 min after aortic declamping (group IP, i.e. IsoPC plus propofol postconditioning). A joint isoflurane and propofol anaesthesia regimen synergistically reduced plasma levels of cTnI (cardiac troponin I) and CK-MB (creatine kinase MB) and f-FABP (heart-type fatty acid-binding protein) (all P < 0.05 compared with control, group P or group I) and facilitated postoperative myocardial functional recovery. During reperfusion, myocardial tissue eNOS (endothelial NO synthase) protein expression in group IP was significantly higher, whereas nitrotyrosine protein expression was lower than those in the control group. In conclusion, a joint isoflurane preconditioning and propofol anaesthesia regimen synergistically attenuated myocardial reperfusion injury in patients. | ||||||
| ISSN | 0143-5221 2011 Impact Factor: 4.317 2011 SCImago Journal Rankings: 0.367 | ||||||
| DOI | http://dx.doi.org/10.1042/CS20100435 | ||||||
| ISI Accession Number ID | WOS:000293155200006
Funding Information: This study is supported, in part, by the National Natural Science Foundation of China (NSFC) [grant number 30872447, 30672033] and by a Society of Cardiovascular Anesthesiologists (SCA) Foundation Starter grant (to Z.X.). | ||||||
| References | References in Scopus |
| dc.contributor.author | Huang, Z | ||||||
|---|---|---|---|---|---|---|---|
| dc.contributor.author | Zhong, X | ||||||
| dc.contributor.author | Irwin, MG | ||||||
| dc.contributor.author | Ji, S | ||||||
| dc.contributor.author | Wong, GTC | ||||||
| dc.contributor.author | Liu, Y | ||||||
| dc.contributor.author | Xia, ZY | ||||||
| dc.contributor.author | Finegan, BA | ||||||
| dc.contributor.author | Xia, Z | ||||||
| dc.date.accessioned | 2011-09-23T05:42:16Z | ||||||
| dc.date.available | 2011-09-23T05:42:16Z | ||||||
| dc.date.issued | 2011 | ||||||
| dc.description.abstract | Either isoflurane preconditioning or high-dose propofol treatment has been shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in patients undergoing CABG (coronary artery bypass graft) surgery. It is unknown whether isoflurane and propofol may synergistically attenuate myocardial injury in patients. The present study investigated the efficacy of IsoPC (isoflurane preconditioning), propofol treatment (postconditioning) and their synergy in attenuating postischaemic myocardial injury in patients undergoing CABG surgery using CPB (cardiopulmonary bypass). Patients (n = 120) selected for CABG surgery were randomly assigned to one of four groups (n = 30 each). After induction, anaesthesia was maintained either with fentanyl and midazolam (control; group C); with propofol at 100 mug x kg(-1) of body weight x min(-1) before and during CPB followed by propofol at 60 mug x kg(-1) of body weight x min(-1) for 15 min after aortic declamping (group P); with isoflurane 1-1.5% end tidal throughout the surgery (group I) or with isoflurane 1-1.5% end tidal before CPB and switching to propofol at 100 mug x kg(-1) of body weight x min(-1) during CPB followed by propofol at 60 mug x kg(-1) of body weight x min(-1) for 15 min after aortic declamping (group IP, i.e. IsoPC plus propofol postconditioning). A joint isoflurane and propofol anaesthesia regimen synergistically reduced plasma levels of cTnI (cardiac troponin I) and CK-MB (creatine kinase MB) and f-FABP (heart-type fatty acid-binding protein) (all P < 0.05 compared with control, group P or group I) and facilitated postoperative myocardial functional recovery. During reperfusion, myocardial tissue eNOS (endothelial NO synthase) protein expression in group IP was significantly higher, whereas nitrotyrosine protein expression was lower than those in the control group. In conclusion, a joint isoflurane preconditioning and propofol anaesthesia regimen synergistically attenuated myocardial reperfusion injury in patients. | ||||||
| dc.description.nature | Link_to_subscribed_fulltext | ||||||
| dc.identifier.citation | Clinical Science, 2011, v. 121 n. 2, p. 57-69 [How to Cite?] DOI: http://dx.doi.org/10.1042/CS20100435 | ||||||
| dc.identifier.doi | http://dx.doi.org/10.1042/CS20100435 | ||||||
| dc.identifier.epage | 69 | ||||||
| dc.identifier.hkuros | 193448 | ||||||
| dc.identifier.isi | WOS:000293155200006
Funding Information: This study is supported, in part, by the National Natural Science Foundation of China (NSFC) [grant number 30872447, 30672033] and by a Society of Cardiovascular Anesthesiologists (SCA) Foundation Starter grant (to Z.X.). | ||||||
| dc.identifier.issn | 0143-5221 2011 Impact Factor: 4.317 2011 SCImago Journal Rankings: 0.367 | ||||||
| dc.identifier.issue | 2 | ||||||
| dc.identifier.pmid | 21291422 | ||||||
| dc.identifier.scopus | eid_2-s2.0-79955583602 | ||||||
| dc.identifier.spage | 57 | ||||||
| dc.identifier.uri | http://hdl.handle.net/10722/138930 | ||||||
| dc.identifier.volume | 121 | ||||||
| dc.language | eng | ||||||
| dc.publisher | Portland Press Ltd. The Journal's web site is located at http://www.clinsci.org/ | ||||||
| dc.publisher.place | United Kingdom | ||||||
| dc.relation.ispartof | Clinical Science | ||||||
| dc.relation.references | References in Scopus | ||||||
| dc.rights | The final version of record is available at [http://www.clinsci.org/cs/default.htm]. | ||||||
| dc.subject.mesh | Ischemic Postconditioning - methods | ||||||
| dc.subject.mesh | Ischemic Preconditioning, Myocardial - methods | ||||||
| dc.subject.mesh | Isoflurane - therapeutic use | ||||||
| dc.subject.mesh | Myocardial Reperfusion Injury - prevention and control | ||||||
| dc.subject.mesh | Propofol - therapeutic use | ||||||
| dc.title | Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients | ||||||
| dc.type | Article |
Author Affiliations
- Hubei General Hospital
- The University of Hong Kong
- University of Alberta
- Zhongshan Ophthalmic Center
- null