Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2015.09.005
Brazilian Journal of Anesthesiology
Scientific Article

Tourniquet-induced ischaemia-reperfusion injury: the comparison of antioxidative effects of small-dose propofol and ketamine

Lesão de isquemia-reperfusão induzida por torniquete: comparação dos efeitos antioxidantes de propofol e cetamina em doses baixas

Karaca Omer; Gogus Nermin; Ahiskalioglu Ali; Aksoy Mehmet; Dogus Unal; Kumas Solak Sezen; Kalafat Hakan

http://dx.doi.org/10.1016/j.bjane.2015.09.005 Braz J Anesthesiol, vol.67, n3, p.246-250, 2017
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Abstract

Abstract Objectives: The aim of the present study was to investigate the preventive effects of propofol and ketamine as small dose sedation during spinal anaesthesia on tourniquet-induced ischaemia-reperfusion injury. Methods: 30 patients were randomly assigned into two groups of 15 patients. In the propofol group, sedation was performed with propofol 0.2 mg·kg-1 followed by infusion at a rate of 2 mg·kg-1·h-1. In the ketamine group, a continuous infusion of ketamine 0.5 mg·kg-1·h-1 was used until the end of surgery. Intravenous administration of midazolam was not used in any patients. Ramsay sedation scale was used for assessing the sedation level. Venous blood samples were obtained before propofol and ketamine infusion (T1), at 30 minutes (min) of tourniquet ischaemia (T2), and 5 min after tourniquet deflation (T3) for malondialdehyde (MDA) measurements. Results: No differences were noted between the groups in haemodynamic (p > 0.05) and demographic data (p > 0.05). There was no statistically significant difference between the two groups in terms of T1, T2 and T3 periods (p > 0.05). There was a statistically increase observed in MDA values respectively both in Group P and Group K between the reperfusion period (1.95 ± 0.59, 2.31 ± 0.48) and pre-ischaemia (1.41 ± 0.38, 1.54 ± 0.45), and ischaemia (1.76 ± 0.70, 1.71 ± 0.38) (µmoL-1) periods (p < 0.05). Conclusions: Small-dose propofol and ketamine has similar potential to reduce the oxidative stress caused by tourniquet-induced ischaemia-reperfusion injury in patients undergoing arthroscopic knee surgery under spinal anaesthesia.

Keywords

Propofol, Ketamine, Arthroscopic knee surgery, Ischaemia reperfusion

Resumo

Resumo Objetivos: O objetivo do presente estudo foi investigar os efeitos preventivos de propofol e cetamina em sedação com doses baixas durante a raquianestesia sobre lesão de isquemia-reperfusão induzida por torniquete. Métodos: 30 pacientes foram randomicamente alocados em dois grupos de 15 pacientes cada. No grupo propofol, a sedação foi feita com 0,2 mg.kg-1 de propofol seguida por infusão a uma taxa de 2 mg.kg-1.h-1. No grupo cetamina, uma infusão contínua de 0,5 mg.kg-1.h-1 de cetamina foi usada até o final da cirurgia. Midazolam intravenoso não foi administrado em nenhum dos pacientes. A Escala de Sedação de Ramsay (ESR) foi usada para avaliar o nível de sedação. Amostras de sangue venoso foram colhidas antes da administração de propofol e infusão de cetamina (T1), aos 30 minutos (min) de isquemia do torniquete (T2) e 5 min após a desinsuflação do torniquete (T3), para medir os valores de malondialdeído (MDA). Resultados: Não observamos diferenças entre os grupos em relação à hemodinâmica (p > 0,05) e dados demográficos (p > 0,05). Não houve diferença estatisticamente significativa entre os dois grupos nos períodos T1, T2 e T3 (p > 0,05). Um aumento estatisticamente significativo foi observado nos valores de MDA, respectivamente, no Grupo P e Grupo C entre os períodos de reperfusão (1,95 ± 0,59, 2,31 ± 0,48) e pré-isquemia (1,41 ± 0,38, 1,54 ± 0,45) e isquemia (1,76 ± 0,70, 1,71 ± 0,38) (µmoL-1) (p < 0,05). Conclusões: Propofol e cetamina em doses baixas apresentam potencial semelhante para reduzir o estresse oxidativo causado pela lesão de isquemia-reperfusão induzida por torniquete em pacientes submetidos à artroscopia de joelho sob raquianestesia.

Palavras-chave

Propofol, Cetamina, Artroscopia do joelho, Isquemia-reperfusão

References

Kharbanda RK, Peters M, Walton B. Ischemic preconditioning prevents endothelial injury and systemic neutrophil activation during ischemia-reperfusion in humans in vivo. Circulation. 2001;103:1624-30.

Gute DC, Ishida T, Yarimizu K. Inflammatory responses to ischemia and reperfusion in skeletal muscle. Mol Cell Biochem. 1998;179:169-87.

Marnett LJ. Lipid peroxidation-DNA damage by malondialdehyde. Mutat Res. 1999;424:83-95.

Yonei S, Furui H. Lethal and mutagenic effects of malondialdehyde, a decomposition product of peroxidized lipids, on Escherichia coli with different DNA-repair capacities. Mutat Res. 1981;88:23-32.

Murphy PG, Myers DS, Davies MJ. The antioxidant potential of propofol (2,6-diisopropylphenol). Br J Anaesth. 1992;68:613-8.

Kahraman S, Demiryurek AT. Propofol is a peroxynitrite scavenger. Anesth Analg. 1997;84:1127-9.

Runzer TD, Ansley DM, Godin DV. Tissue antioxidant capacity during anesthesia: propofol enhances in vivo red cell and tissue antioxidant capacity in a rat model. Anesth Analg. 2002;94:89-93.

Ahiskalioglu A, Ince I, Aksoy M. Comparative investigation of protective effects of metyrosine and metoprolol against ketamine cardiotoxicity in rats. Cardiovasc Toxicol. 2014.

Lips J, de Haan P, Bodewits P. Neuroprotective effects of riluzole and ketamine during transient spinal cord ischemia in the rabbit. Anesthesiology. 2000;93:1303-11.

Cheng YJ, Wang YP, Chien CT. Small-dose propofol sedation attenuates the formation of reactive oxygen species in tourniquet-induced ischemia-reperfusion injury under spinal anesthesia. Anesth Analg. 2002;94:1617-20.

Saricaoglu F, Dal D, Salman AE. Ketamine sedation during spinal anesthesia for arthroscopic knee surgery reduced the ischemia-reperfusion injury markers. Anesth Analg. 2005;101:904-9.

Buttke TM, Sandstrom PA. Oxidative stress as a mediator of apoptosis. Immunol Today. 1994;15:7-10.

Calikoglu M, Tamer L, Sucu N. The effects of caffeic acid phenethyl ester on tissue damage in lung after hindlimb ischemia-reperfusion. Pharmacol Res. 2003;48:397-403.

Ng A, Tan SS, Lee HS. Effect of propofol infusion on the endocrine response to cardiac surgery. Anaesth Intensive Care. 1995;23:543-7.

Tsuchiya M, Asada A, Kasahara E. Antioxidant protection of propofol and its recycling in erythrocyte membranes. Am J Respir Crit Care Med. 2002;165:54-60.

Murphy PG, Bennett JR, Myers DS. The effect of propofol anaesthesia on free radical-induced lipid peroxidation in rat liver microsomes. Eur J Anaesthesiol. 1993;10:261-6.

Zhou M, Ma T, Tseng MT. Effects of taurine and ketamine on bovine retinal membrane lipid peroxidation. Neuroscience. 1991;45:461-5.

Guzman-de la Garza FJ, Camara-Lemarroy CR, Ballesteros-Elizondo RG. Ketamine and the myenteric plexus in intestinal ischemia/reperfusion injury. Dig Dis Sci. 2010;55:1878-85.

Yuzer H, Yuzbasioglu MF, Ciralik H. Effects of intravenous anesthetics on renal ischemia/reperfusion injury. Ren Fail. 2009;31:290-6.

Li Volti G, Basile F, Murabito P. Antioxidant properties of anesthetics: the biochemist, the surgeon and the anesthetist. Clin Ter. 2008;159:463-9.

Tsuchiya M, Asada A, Maeda K. Propofol versus midazolam regarding their antioxidant activities. Am J Respir Crit Care Med. 2001;163:26-31.

Parks DA, Granger DN. Contributions of ischemia and reperfusion to mucosal lesion formation. Am J Physiol. 1986;250:G749-53.

Petrone WF, English DK, Wong K. Free radicals and inflammation: superoxide-dependent activation of a neutrophil chemotactic factor in plasma. Proc Natl Acad Sci U S A. 1980;77:1159-63.

Di Pierro D, Tavazzi B, Lazzarino G. Malondialdehyde is a biochemical marker of peroxidative damage in the isolated reperfused rat heart. Mol Cell Biochem. 1992;116:193-6.

Concannon MJ, Kester CG, Welsh CF. Patterns of free-radical production after tourniquet ischemia: implications for the hand surgeon. Plast Reconstr Surg. 1992;89:846-52.

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