The function and mechanism of remifentanil in flap ischemia-reperfusion injury

Abstract

Objective To investigate the function and mechanism of remifentanil in flap ischemiareperfusion injury (IRI).Methods A totol of 80 adult male SD rats were randomly divided into 4 groups:sham-operated group (n =20),IRI group (n =20),remifentanil group (n =20) and Toll-like receptor 4 (TLR4) inhibitor group (n＝20).Flap IRI model was established.Remifentanil group and TLR4 inhibitor group before reperfusion were intravenously injected with remifentanil 1 μg/(kg· min) and E5564 (5 mg/kg),respectively.At 2,4 and 8 h after I/R,real-time quantitative polymerase chain reaction (Real-time PCR) and Western blotting were applied to detect the expression of TLR4 and nuclear factor-κB (NF-κB) in the flap tissue.On the postoperative day 7,image analysis software was used to calculate flap survival rate.Results The Real-time PCR and Western blotting showed that the expression of TLR4 and NF-κB was significantly enhanced in IRI group as compared with remifentanil group and TLR4 inhibitor group.The expression of TLR4 and NF-κB was inhibited after reperfusion in remifentanil group and TLR4 inhibitor group.On the postoperative day 7,the flap survival rate in IRI group,remifentanil group and TLR4 inhibitor group was (61.40 ±7.12)％,(80.31 ± 11.63)％ and (82.10 ± 10.21)％ respectively,and there was significant difference between IRI group and remifentanil group or TLR4 inhibitor group (P ＜ 0.05 for both).Conclusion Remifentanil may alleviate flap IRI by inhibiting TLR4 expression and activation of NF-κB. Key words: Remifentanil ; Flap ischemia; Reperfusion injury; Toll-like receptor 4 ; Nuclear factor-κB