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Article: Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients

TitleSynergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients
Authors
Issue Date2011
PublisherPortland 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?
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.
Persistent Identifierhttp://hdl.handle.net/10722/138930
ISSN
2013 Impact Factor: 5.629
ISI Accession Number ID
Funding AgencyGrant Number
National Natural Science Foundation of China (NSFC)30872447
30672033
Society of Cardiovascular Anesthesiologists (SCA) Foundation
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

 

Author Affiliations
  1. Hubei General Hospital
  2. The University of Hong Kong
  3. University of Alberta
  4. Zhongshan Ophthalmic Center
  5. Sun Yat-sen Cardiovascular Hospital
DC FieldValueLanguage
dc.contributor.authorHuang, Zen_HK
dc.contributor.authorZhong, Xen_HK
dc.contributor.authorIrwin, MGen_HK
dc.contributor.authorJi, Sen_HK
dc.contributor.authorWong, GTCen_HK
dc.contributor.authorLiu, Yen_HK
dc.contributor.authorXia, ZYen_HK
dc.contributor.authorFinegan, BAen_HK
dc.contributor.authorXia, Zen_HK
dc.date.accessioned2011-09-23T05:42:16Z-
dc.date.available2011-09-23T05:42:16Z-
dc.date.issued2011en_HK
dc.identifier.citationClinical Science, 2011, v. 121 n. 2, p. 57-69en_HK
dc.identifier.issn0143-5221en_HK
dc.identifier.urihttp://hdl.handle.net/10722/138930-
dc.description.abstractEither 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.en_HK
dc.languageengen_US
dc.publisherPortland Press Ltd. The Journal's web site is located at http://www.clinsci.org/en_HK
dc.relation.ispartofClinical Scienceen_HK
dc.rightsThe final version of record is available at [http://www.clinsci.org/cs/default.htm].-
dc.subject.meshIschemic Postconditioning - methodsen_HK
dc.subject.meshIschemic Preconditioning, Myocardial - methodsen_HK
dc.subject.meshIsoflurane - therapeutic useen_HK
dc.subject.meshMyocardial Reperfusion Injury - prevention and controlen_HK
dc.subject.meshPropofol - therapeutic useen_HK
dc.titleSynergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patientsen_HK
dc.typeArticleen_HK
dc.identifier.emailHuang, Z: zyhuang@hkucc.hku.hken_HK
dc.identifier.emailIrwin, MG: mgirwin@hku.hken_HK
dc.identifier.emailWong, GTC: gordontcwong@hotmail.comen_HK
dc.identifier.emailXia, Z: zyxia@hkucc.hku.hk-
dc.identifier.authorityIrwin, MG=rp00390en_HK
dc.identifier.authorityWong, GT=rp00523en_HK
dc.identifier.authorityXia, Z=rp00532en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1042/CS20100435en_HK
dc.identifier.pmid21291422en_HK
dc.identifier.scopuseid_2-s2.0-79955583602en_HK
dc.identifier.hkuros193448en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79955583602&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume121en_HK
dc.identifier.issue2en_HK
dc.identifier.spage57en_HK
dc.identifier.epage69en_HK
dc.identifier.eissn1470-8736-
dc.identifier.isiWOS:000293155200006-
dc.publisher.placeUnited Kingdomen_HK

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