Study on the Effects of Sevoflurane and Propofol on Reperfusion after Partial Thoracic Aortic Cross-Clamping: Is Sevoflurane Superior to Propofol in Relation to Blood Flow and Markers of Tissue Injury and Inflammation?

Abstract

Background: Clamping of the aorta leads to an ischemia-reperfusion syndrome, hemodynamic consequences, and changes on serum markers of cellular injury such as pro-/anti-inflammatory cytokines release, and oxygen free radicals. During cardiovascular surgery, sevoflurane and propofol are frequently used. Sevoflurane induces organ protection in the ischemia-reperfusion syndrome and has been shown to be superior to propofol in ischemia caused by total occlusion of the thoracic aorta (sevoflurane has better hemodynamic stability and lower release of markers of tissue injury), but this effect in partial cross-clamping has not been studied. The aim of this study was to assess the effect of sevoflurane and propofol on organ blood flow after partial thoracic aortic cross-clamping. Methods: Ten healthy mini-pigs were divided into two groups (5 each) based on the anaesthetic administered (sevoflurane or propofol). Following a median sternotomy, a 20-minute partial cross-clamp was applied to the ascending thoracic aorta. Organ blood flow (measured using colored microspheres), serum markers of tissue injury, markers of inflammation, atrial peptide natriuretic peptide, and nitric oxide were all measured at baseline (before partial aortic cross-clamping) and 30 minutes after the partial aortic cross-clamping was removed. Results: After 30 minutes of reperfusion, there were no significant differences in blood flow in the brain (both frontal lobes), heart (both ventricles), liver, lung, kidney, or ileum. Both groups had similar markers of tissue injury, inflammation, and nitric oxide. Conclusions: In summary, our findings show that sevoflurane is not superior to propofol in terms of blood flow, markers of tissue injury, markers of inflammation, and nitric oxide after partial cross-clamping of the thoracic aorta. Study Objectives: Study organ blood flow (measured by colored microspheres), serum markers of tissue injury, markers of inflammation, atrial peptide natriuretic and nitric oxide at baseline (before partial aortic cross-clamping) and 30 minutes after removal of partial aortic cross-clamping in ten healthy mini-pigs, who were block-randomized to receive either propofol in continuous perfusion as anesthetic maintenance or sevoflurane.