Abstract
BackgroundMetabolic status can be impacted by general anesthesia and surgery. However, the exact effects of general anesthesia and surgery on systemic metabolome remain unclear, which might contribute to postoperative outcomes.MethodsFive hundred patients who underwent abdominal surgery were included. General anesthesia was mainly maintained with sevoflurane. The end-tidal sevoflurane concentration (ETsevo) was adjusted to maintain BIS (Bispectral index) value between 40 and 60. The mean ETsevo from 20 min after endotracheal intubation to 2 h after the beginning of surgery was calculated for each patient. The patients were further divided into low ETsevo group (mean − SD) and high ETsevo group (mean + SD) to investigate the possible metabolic changes relevant to the amount of sevoflurane exposure.ResultsThe mean ETsevo of the 500 patients was 1.60% ± 0.34%. Patients with low ETsevo (n = 55) and high ETsevo (n = 59) were selected for metabolomic analysis (1.06% ± 0.13% vs. 2.17% ± 0.16%, P < 0.001). Sevoflurane and abdominal surgery disturbed the tricarboxylic acid cycle as identified by increased citrate and cis-aconitate levels and impacted glycometabolism as identified by increased sucrose and D-glucose levels in these 114 patients. Glutamate metabolism was also impacted by sevoflurane and abdominal surgery in all the patients. In the patients with high ETsevo, levels of L-glutamine, pyroglutamic acid, sphinganine and L-selenocysteine after sevoflurane anesthesia and abdominal surgery were significantly higher than those of the patients with low ETsevo, suggesting that these metabolic changes might be relevant to the amount of sevoflurane exposure.ConclusionsSevoflurane anesthesia and abdominal surgery can impact principal metabolic pathways in clinical patients including tricarboxylic acid cycle, glycometabolism and glutamate metabolism. This study may provide a resource data for future studies about metabolism relevant to general anaesthesia and surgeries.Trial registrationwww.chictr.org.cn. identifier: ChiCTR1800014327.
Highlights
Volatile anesthetics have been used in clinical setting for more than 170 years, how volatile anesthetics impact physiological status is still elusive [1]
In the patients with high end-tidal sevoflurane concentration (ETsevo), levels of L-glutamine, pyroglutamic acid, sphinganine and L-selenocysteine after sevoflurane anesthesia and abdominal surgery were significantly higher than those of the patients with low ETsevo, suggesting that these metabolic changes might be relevant to the amount of sevoflurane exposure
Our results indicated that the level of L-glutamine was higher in the group H after anesthesia/abdominal surgery than that in the group L, which might be related to the differential functions in excitatory synaptic transmission and excitatory neurotransmitter release during sevoflurane anesthesia
Summary
Volatile anesthetics have been used in clinical setting for more than 170 years, how volatile anesthetics impact physiological status is still elusive [1]. It is widely known that general anesthetics can impact some important processes of metabolism [2, 3] and metabolic connectivity [4]. General anesthesia induced by sevoflurane can change metabolic activity in the central nervous system detected by functional neuroimaging [5]. The exact modulation of general anesthetics on systemic metabolome in human has not been clearly illustrated. Understanding the exact effects of volatile anesthetics on systemic metabolism is important for perioperative management of patients, because it can be involved in postoperative recovery [8], postoperative cognitive function [9] and infection [10]. Metabolic status can be impacted by general anesthesia and surgery. The exact effects of general anesthesia and surgery on systemic metabolome remain unclear, which might contribute to postoperative outcomes
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