Effects of Sevoflurane and Propofol on Intestinal Ischemic Reperfusion Injury in Patients Undergoing Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial

Abstract

Background: We previously demonstrated that propofol had a protective effect on the intestine at risk after an ischemic injury in a rat model. The current study tested the hypothesis that such beneficial effects, so far mainly seen in the laboratory, are reproducible in humans.Methods: Seventy patients undergoing elective open infrarenal abdominal aortic aneurysm repair were randomized to receive general anesthesia with either propofol or sevoflurane. General anesthesia was induced with 3 µg/kg fentanyl, 0.2 mg/kg cisatracurium, and target-controlled infusion of propofol, set at a plasma target concentration of 4-6 µg/ml, or sevoflurane initially started at 8%. Anesthesia was maintained with target-controlled infusion of propofol (2-4 µg/ml) or sevoflurane (0.8-1.0 minimum alveolar concentration). Except for this, anesthetic and surgical management was the same in both groups. Serum intestinal fatty acid binding protein was taken as the primary outcome for evaluating intestinal injury. The secondary outcomes included other intestinal injury variables (serum endotoxin levels, serum diamine oxidase activity and the score of intestinal injury severity) as well as markers reflecting oxidative stress and systemic inflammatory response.Results: The levels of biomarkers reflecting intestinal injury were higher than baseline in both groups (all P<0.05). However, in sevoflurane-anesthetized patients, these variables increased significantly more than those in patients anesthetized with propofol (all P<0.05), whereas the scores of the intestinal injury severity didn't differ between two groups (P=0.53).Conclusions: Patients receiving propofol for abdominal aortic aneurysm repair surgery had less intestinal injury than patients receiving sevoflurane, which may be related to its better anti-oxidative property. Citation: Cai Li, Wu Yan, Jian- Tong Shen, Shi-Hong Wen, Ke-Xuan Liu. Effects of sevoflurane and propofol on intestinal ischemic reperfusion injury in patients undergoing elective open infrarenal abdominal aortic aneurysm repair: a randomized controlled trial. J Anesth Perioper Med 2015; 2: 126-35. Published on April 30, 2015. doi: 10.24015/JAPM.2015.0018This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.