Abstract
Propofol is an intravenous anesthetic, reported to have a protective effect against ischemia/reperfusion (I/R) injury in heart and brain, but no definite data are available concerning its effect in hepatic I/R. This work investigated the effect of propofol anesthesia on hepatic I/R injury using in vivo rat model. Four groups of rats were included: sham operated, I/R (30 min ischemia and 2 h reperfusion), I/R treated with propofol (10 mg/kg/h), and I/R treated with propofol (20 mg/kg/h). Liver enzyme leakage, TNF-α and caspase-3 levels, and antiapoptotic Bcl-xL/apoptotic Bax gene expression, together with histopathological changes, were used to evaluate the extent of hepatic I/R injury. Compared with sham-operated group, I/R group showed significant increase in serum levels of liver enzymes (ALT, AST), TNF-α, and caspase-3 and significant decrease in the Bcl-xL/Bax ratio, associated with histopathologic damage in liver. Propofol infusion significantly attenuated these changes with reduced hepatic histopathologic lesions compared with nonpreconditioned I/R group. However, no significant differences were found between two groups treated with different doses of propofol. In conclusion, propofol infusion reduced hepatic I/R injury with decreased markers of cellular apoptosis. Therefore, propofol anesthesia may provide a useful hepatic protection during liver surgery.
Highlights
Liver ischemia/reperfusion (I/R) injury is a common pathophysiological process prevalent in hepatic transplant surgery, partial hepatectomy, and shock conditions
By analyzing the effect of propofol on the expression of different genes involved in apoptosis, we found that propofol infusion, at both doses, leads to upregulation of the antiapoptotic Bcl-xL gene expression and downregulation of the proapoptotic Bax gene expression, with significant increase in the Bcl-xL/Bax ratio in the propofol preconditioned I/R groups compared with the nonpreconditioned I/R group (P < 0.05)
Propofol was shown to have protective effect in myocardial and neuronal I/R but no definite data available concerning the potential benefit of total anesthesia with propofol in hepatic surgery
Summary
Liver ischemia/reperfusion (I/R) injury is a common pathophysiological process prevalent in hepatic transplant surgery, partial hepatectomy, and shock conditions. Liver failure induced by I/R is the most serious complication with a direct impact on prognosis of the disease and even causes deaths [1]. This accounts for about 80% of liver transplant failures and the high mortality rate after partial hepatectomy [2]. Several mechanisms interact during I/R to cause liver damage and death of liver cells, including the direct ischemic cellular damage as well as cell injury due to activation of inflammatory response after reperfusion [1]. The inflammatory cytokine tumor necrosis factor alpha (TNF-α) has been incriminated in pathogenesis of hepatic I/R injury [8], where it may exacerbate hepatic cellular apoptosis [9]
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