Abstract
Objective The inhalation anesthetic sevoflurane has presented numerous biological activities, including anti-inflammatory properties and protective effects against tissue ischemic injury. This study investigated the metabolic, hemodynamic, and inflammatory effects of sevoflurane pre- and postconditioning for short periods in the rescue of liver ischemia-reperfusion (IR) injury using a rat model. Materials and Methods Twenty Wistar rats were divided into four groups: sham group, control ischemia group (partial warm liver ischemia for 45 min followed by 4 h of reperfusion), SPC group (administration of sevoflurane 2.5% for 15 min with 5 min of washout before liver IR), and SPPoC group (administration of sevoflurane 2.5% for 15 min before ischemia and 20 min during reperfusion). Results All animals showed a decrease in the mean arterial pressure (MAP) and portal vein blood flow during ischemia. After 4 h of reperfusion, only the SPPoC group had MAP recovery. In both the SPC and SPPoC groups, there was a decrease in the ALT level and an increase in the bicarbonate and potassium serum levels. Only the SPPoC group showed an increase in the arterial blood ionized calcium level and a decrease in the IL-6 level after liver reperfusion. Therefore, this study demonstrated that sevoflurane preconditioning reduces hepatocellular injury and acid-base imbalance in liver ischemia. Furthermore, sevoflurane postconditioning promoted systemic hemodynamic recovery with a decrease in inflammatory response.
Highlights
Ischemia-reperfusion (IR) injury is still a major problem that impairs liver transplantation (LT) and surgery outcome.Multiple inflammatory and metabolic pathways that are involved in liver IR injury are still unclear [1]
In the sham group (n = 5), we performed midline laparotomy and liver manipulation without IR; in the control (C) ischemia group (n = 5), animals that did not receive volatile anesthetics (VAs) were subjected to liver ischemia for 45 min; in the sevoflurane preconditioning (SPC) group (n = 5), animals received sevoflurane (Abbott Laboratories, USA) for 15 min followed by 5 min of washout before liver ischemia; and in the sevoflurane pre- and postconditioning (SPPoC) group (n = 5), animals received sevoflurane before liver ischemia as in the SPC group and 20 min of sevoflurane after reperfusion
At 4 h after reperfusion, mean arterial pressure (MAP) recovered in the C group (91 4 ± 37 96 vs. 115 6 ± 15 57 mmHg) and decreased in the SPC (64 6 ± 23 38 vs. 118 2 ± 37 06 mmHg) and SPPoC (93 0 ± 15 73 vs. 124.0 ± 17.28 mmHg) groups compared to the baseline
Summary
Ischemia-reperfusion (IR) injury is still a major problem that impairs liver transplantation (LT) and surgery outcome.Multiple inflammatory and metabolic pathways that are involved in liver IR injury are still unclear [1]. Ischemia-reperfusion (IR) injury is still a major problem that impairs liver transplantation (LT) and surgery outcome. Strategies applied to decrease liver IR injury have obtained only partial response with scant application in the clinical Baseline C. Wash out SPPoC setting due to side effects In this setting, volatile anesthetics (VAs) such as sevoflurane, which are commonly used in clinical practice, arise as a promising strategy to prevent IR injury [2, 3]. In liver surgery, pharmacological postconditioning with sevoflurane decreases liver injury with better patient outcome comparable with the results of intermittent clamping [6], and similar benefits are observed with preconditioning [7]. In LT, Minou et al [8] showed that sevoflurane preconditioning applied during deceased donor surgery decreases postoperative AST peak and incidence of early graft dysfunction
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