Abstract
Purpose
To compare low vs high dose propofol and isoflurane on red cell RBC antioxidant capacity in patients during aortocoronary bypass surgery (ACBP).
Methods
Twenty-one patients, for ACBR were anesthetized with sufentanil 0.5–10 μg·kg−1 and isoflurane 0–2%; ISO = control; n=7), or sufentanil 0.3 μg·kg−1, propofol 1–2.5 μg·kg−1 bolus then 100μg·kg−1 before, and 50 μg·kg−1·min−1 during CPB (LO; n=7), or sufentanil 0.3 μg·kg−1, propofol 2–2.5 μg·kg−1 bolus then 200 μg·kg−1·min−1 (HI; n=7). Venous blood was drawn pre-and post-induction, after 30 min CPB, 5, 10, and 30 min of reperfusion, and 120 min post-CPB to measure red cell antioxidant capacity (malondialdehyde (MDA) production in response to oxidative challenge with t-butyl hydrogen peroxide) and plasma propofol concentration. Preinduction blood samples were analyzed for antioxidant effects of nitrates on red cells. The tBHP concentration response curves for RBC MDA in ISO, LO and HI were determined.
Results
Preoperative nitrate therapy did not effect RBC MDA production. Perioperative RBC MDA production was similar in ISO and LO groups. Sustained intraoperative decrease in RBC MDA was seen with propofol 8.0 ± 2.4 − 11.8 ± 4.5 μg·ml−1 in HI (P < 0.05- 0.0001). MDA production vs log plasma propofol concentration was linear in HI dose.
Conclusions
During CPB, RBC antioxidant capacity is enhanced and maintained with HI dose propofol. Propofol, at this dose, may prove useful in protecting against cardiopulmonary ischemia-reperfusion injury associated with ACBR
Résumé
Objectif
Comparer une faible dose (LO) vs une forte dose (HI) de propofol et d’isoflurane sur la capacité antioxydante des globules rouges (GR) lors d’un pontage aortocoronarien (PAC).
Méthode
Lors d’un PAC, 21 patients ont reçu une anesthésie avec du sufentanil 0,5–10 μg·ml−1 et de l’isoflurane 0–2 %; (ISO = témoin, n = 7) ou du sufentanil 0,3 μg·kg−1 un bolus de propofol 1–2,5 μg·kg−1 suivi d’une perfusion de 100 μg·kg−1·min−1 avant le PAC et de 50 μg·kg−1·min−1 pendant le PAC (LO, n = 7), ou du sufentanil 0,3 μg·kg−1, un bolus de propofol 2–2,5 μg·kg−1 et une perfusion de 200 μg·kg−1·min−1 (HI, n = 7). Le sang veineux a été prélevé avant et après l’induction, 30 min après le PAC, à 5, 10 et 30 min pendant la reperfusion et 120 min après la CEC afin de mesurer la capacité antioxydante des GR (production de dialdéhyde malonique DAM en réponse à la provocation oxydante avec du peroxyde d’hydrogène t-butyl PHtB) et la concentration plasmatique de propofol. Les échantillons de sang prélevés avant l’induction ont été analysés pour vérifier les effets antioxydants des nitrates sur les GR. Les courbes illustrant la réaction des GR au DAM chez les patients des groupes ISO, LO et HI ont été déterminées.
Résultats
La thérapie préopératoire aux nitrates n’a pas changé la capacité antioxydante des GR, donc la production de DAM a été semblable dans les groupes ISO et LO. Une baisse peropératoire de production de DAM a toutefois été observée avec 8,0 ± 2,4 – 11,8 ± 4.5 μg·ml−1 de propofol dans le groupe HI (P < 0,05 - 0,0001). La production de DAM vs le logarithme de la concentration plasmatique de propofol était linéaire dans le groupe HI.
Conclusion
Pendant la CEC, la capacité antioxydante des GR a été améliorée et maintenue par une forte dose de propofol. Administré selon cette dose, le propofol peut se révéler utile pour protéger des lésions cardio-pulmonaires liées à l’ischémie de reperfusion associée au PAC.
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Ansley, D.M., Sun, J., Visser, W.A. et al. High dose propofol enhances red cell antioxidant capacity during CPB in humans. Can J Anesth 46, 641–648 (1999). https://doi.org/10.1007/BF03013951
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DOI: https://doi.org/10.1007/BF03013951