Document Detail


Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients.
MedLine Citation:
PMID:  21291422     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 μg x kg(-1) of body weight x min(-1) before and during CPB followed by propofol at 60 μg 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 μg x kg(-1) of body weight x min(-1) during CPB followed by propofol at 60 μg 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.
Authors:
Zhiyong Huang; Xingwu Zhong; Michael G Irwin; Shangyi Ji; Gordon T Wong; Yanan Liu; Zhong-Yuan Xia; Barry A Finegan; Zhengyuan Xia
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical science (London, England : 1979)     Volume:  121     ISSN:  1470-8736     ISO Abbreviation:  Clin. Sci.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-04-04     Completed Date:  2011-06-28     Revised Date:  2011-10-20    
Medline Journal Info:
Nlm Unique ID:  7905731     Medline TA:  Clin Sci (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  57-69     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Sun Yat-Sen Cardiovascular Hospital, Shenzhen, People’s Republic of China.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthetics, Inhalation / therapeutic use
Anesthetics, Intravenous / therapeutic use
Antioxidants / metabolism
Coronary Artery Bypass / adverse effects
Cytokines / metabolism
Drug Synergism
Female
Hemodynamics
Humans
Inflammation Mediators / metabolism
Ischemic Postconditioning / methods*
Ischemic Preconditioning, Myocardial / methods*
Isoflurane / therapeutic use*
Male
Middle Aged
Myocardial Reperfusion Injury / prevention & control*
Nitric Oxide Synthase Type III / metabolism
Propofol / therapeutic use*
Tyrosine / analogs & derivatives,  metabolism
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Antioxidants; 0/Cytokines; 0/Inflammation Mediators; 2078-54-8/Propofol; 26675-46-7/Isoflurane; 3604-79-3/3-nitrotyrosine; 55520-40-6/Tyrosine; EC 1.14.13.39/NOS3 protein, human; EC 1.14.13.39/Nitric Oxide Synthase Type III

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