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Isoflurane preconditioning-induced cardio-protection in patients undergoing coronary artery bypass grafting

Published online by Cambridge University Press:  01 March 2006

M.-C. Lee ,
C.-H. Chen ,
M.-C. Kuo ,
P.-L. Kang ,
A. Lo  and
K. Liu
M.-C. Lee
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan
C.-H. Chen
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan Kaohsiung Veterans General Hospital, Department of Cardiovascular Surgery, Kaohsiung, Taiwan
M.-C. Kuo
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan
P.-L. Kang
Affiliation:
Chang Gung University, Graduate Institute of Clinical Medical Sciences, Taoyuan, Taiwan
A. Lo
Affiliation:
Chang Gung University, Graduate Institute of Clinical Medical Sciences, Taoyuan, Taiwan
K. Liu
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan
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Abstract

Summary

Background and objectives: Ischaemic preconditioning is commonly regarded as one of the most powerful protective mechanisms against a subsequent lethal ischaemic injury during coronary artery bypass graft surgery but is not practiced routinely. Experimentally, isoflurane, a commonly used volatile anaesthetic agent, provides myocardial protection through a signal transduction cascade that is remarkably similar to the pathways identified in ischaemic preconditioning. The aim of our study was to investigate whether pre-ischaemic administration of isoflurane exerted protection against prolonged ischaemia with functional recovery and reduced necrosis among patients undergoing coronary artery bypass graft surgery. Methods: Forty patients scheduled for elective coronary artery bypass graft operations were prospectively randomized into the control or isoflurane groups. In the isoflurane group, isoflurane 2.5 minimum alveolar concentration was administered for 15 min followed by a 5-min washout period before aortic cross-clamping. The control group received a time-matched period of isoflurane-free cardiopulmonary bypass. The conduction of anaesthesia and surgery were standardized in all patients. Haemodynamic data, troponin I release and inotropic support were measured and recorded perioperatively. Results: There were no adverse effects related to isoflurane administration. In the isoflurane group, the mean cardiac index after cardiopulmonary bypass was significantly higher than the pre-bypass value (P < 0.05), whereas no difference was found in the control group. At 15 min after cardiopulmonary bypass and 6 h after surgery, the changes in cardiac index and stroke volume index were significantly higher in the isoflurane group than in the control group (P < 0.05). There was a consistently lower release of troponin I in the isoflurane group compared to the control group. Compared to the controls, the mean troponin I level was significantly reduced in the isoflurane group at 24 h after surgery (P = 0.042). Conclusions: The present results support the preconditioning effect of isoflurane in patients undergoing coronary artery bypass graft surgery as clinically feasible and providing optimal cardiac protection.

Keywords

ISCHAEMIC PRECONDITIONING, myocardialANAESTHETICS, INHALATIONAL, isofluraneCARDIOPULMONARY BYPASS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 10 , October 2006 , pp. 841 - 847
Copyright
2006 European Society of Anaesthesiology

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References

Khuri SF, Farhat T, Zankoul Fet al. Intraoperative assessment of the stunned versus infarcted myocardium with the simultaneous use of transesophageal echocardiography and the measurement of myocardial pH: two case studies. J Cardiac Surg 1994; 9 (Suppl 3): 403–409.Google Scholar
Bounous EP, Mark DB, Pollock BGet al. Surgical survival benefits for coronary disease patients with left ventricular dysfunction. Circulation 1988; 78: I151–I157.Google Scholar
Ely SW, Berne RM. Protective effect of adenosine in myocardial ischemia. Circulation 1992; 85: 893–904.Google Scholar
Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74: 1124–1136.Google Scholar
Cave AC. Preconditioning induced protection against post-ischemic contractile dysfunction: characteristics and mechanisms. J Mol Cell Cardiol 1995; 27: 969–979.Google Scholar
Kaukoranta PK, Martti PK, Ylitalo KV, Kiviluoma KT, Peuhkurinen KJ. Normothermic retrograde blood cardioplegia with or without preceding ischemic preconditioning. Ann Thorac Surg 1997; 63: 1268–1274.Google Scholar
Eltchaninoff H, Cribier A, Tron C, Derumeaux G, Koning R, Hecketsweiller Bet al. Adaptation to myocardial ischemia during coronary angioplasty demonstrated by clinical, electrocardiographic, echocardiographic, and metabolic parameters. Am Heart J 1997; 133: 490–496.Google Scholar
Ghosh S, Standen NB, Galinanes M. Preconditioning the human myocardium by stimulated ischemia studies on the early and delayed protection. Cardiovasc Res 2000; 45: 339–350.Google Scholar
Walker DM, Walker JM, Pugsley WB, Pattison CW, Yellon DM. Preconditioning in isolated superfused human muscle. J Mol Cell Cardiol 1995; 27: 1349–1357.Google Scholar
Toller WG, Kersten JR, Pagel PS, Warltier DC. Ischemic preconditioning, myocardial stunning and anesthesia. Curr Opin Anaesthesiol 2000; 13: 35–40.Google Scholar
Schulz R, Cohen MV, Behrends M, Downey JM, Heusch G. Signal transduction of ischemic preconditioning. Cardiovasc Res 2001; 52: 181–198.Google Scholar
Baxter GF, Ferdinandy P. Delayed preconditioning of myocardium: current perspectives. Basic Res Cardiol 2001; 96: 329–344.Google Scholar
Kloner RA, Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: Part 2. Circulation 2001; 104: 3158–3167.Google Scholar
Hawaleshka A. Ischemic preconditioning: mechanisms and potential clinical applications. Can J Anaesth 1998; 45: 670–682.Google Scholar
D'Attellis N.Anesthetic preconditioning: target the right patients. Anaesthesiology, 2003; 98: 796–797.CrossRefGoogle Scholar
Hanouz JL, Yvon A, Massetti M, Lepage O, Babatasi G, Khayat Aet al. Mechanisms of desflurane-induced preconditioning in isolated human right atria in vitro. Anaesthesiology 2002; 97: 33–41.Google Scholar
Toller WG, Gross ER, Kersten JR, Pagel PS, Gross GJ, Warltier DC. Sarcolemmal and mitochondrial adenosine triphosphate-dependent potassium channels: mechanism of desflurane-induced cardioprotection. Anaesthesiology 2000; 92: 1731–1739.Google Scholar
Toller WG, Kersten JR, Gross ER, Pagel PS, Warltier DC. Isoflurane preconditions myocardium against infarction via activation of inhibitory guanine nucleotide binding proteins. Anaesthesiology 2000; 92: 1400–1407.Google Scholar
Stadnicka A, Kwok WM, Warltier DC, Bosnjak ZJ. Protein tyrosine kinase-dependent modulation of isoflurane effects on cardiac sarcolemmal K (ATP) channel. Anaesthesiology 2002; 97: 1198–1208.Google Scholar
Kohro S, Hogan QH, Nakae Y, Yamakage M, Bosnjak ZJ. Anesthetic effects on mitochondrial ATP-sensitive K channel. Anaesthesiology 2001; 95: 1435–1440.Google Scholar
Kato R, Foex P. Myocardial protection by anesthetic agents against ischemia-reperfusion injury: an update for anesthesiologists. Can J Anaesth 2002; 49: 777–791.Google Scholar
Van Winkle DM, Thornton JD, Downey DM, Downey JM. The natural history of preconditioning: cardioprotection depends on duration of transient ischemic and time to subsequent ischemia. Coronary Artery Dis 1991; 2: 613–619.Google Scholar
Kuzuya T, Hoshida S, Yamashita Net al. Delayed effects of sublethal ischemia on the acquisition of tolerance to ischemia. Circ Res 1993; 72: 1293–1299.Google Scholar
Przyklenk K, Kloner RA. Ischemic preconditioning: exploring the paradox. Prog Cardiovasc Dis 1998; 409: 517–547.Google Scholar
Kersten JR, Schmeling TJ, Pagel PS, Gross GJ, Warltier DC. Isoflurane mimics ischemic preconditioning via activation of KATP channels: reduction of myocardial infarct size with an acute memory phase. Anaesthesiology 1997; 87: 361–370.Google Scholar
Cason BA, Gamperl AK, Slocum RE, Hickey RF. Anesthetic-induced preconditioning: previous administration of isoflurane decreases myocardial infarct size in rabbits. Anaesthesiology 1997; 87: 1182–1190.Google Scholar
Cope DK, Impastato WK, Cohen MV, Downey JM. Volatile anesthetics protect the ischemic rabbit myocardium from infarction. Anaesthesiology 1997; 86: 699–709.Google Scholar
Ismaeil MS, Tkachenko I, Gamperl AK, Hickey RF, Cason BA. Mechanisms of isoflurane-induced myocardial preconditioning in rabbits. Anaesthesiology 1999; 90: 812–821.Google Scholar
Belhomme D, Peynet J, Louzy M, Launay JM, Kitakaze M, Menasche P. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation 1999; 100 (Suppl): II340–II344.Google Scholar
Tomai F, De Paulis R, Penta de Peppo Aet al. Beneficial impact of isoflurane during coronary bypass surgery on troponin I release. G Ital Cardiol 1999; 29: 1007–1014.Google Scholar
Haroun-Bizri S, Khoury SS, Chehab IR, Kassas CM, Baraka A. Does isoflurane optimize myocardial protection during cardiopulmonary bypass? J Cardiothorac Vasc Anaesth 2001; 15: 418–421.Google Scholar
Lee HT, LaFaro RJ, Reed GE. Pretreatment of human myocardium with adenosine during open heart surgery. J Card Surg 1995; 10: 665–676.Google Scholar
Kloner R, Przyklenk K, Kay G. Clinical evidence for stunned myocardium after coronary artery bypass surgery. J Card Surg 1994; 9: 397–402.Google Scholar
Warltier DC, Al-Wathiqui MH, Kampine JP, Schmeling WT. Recovery of contractile function of stunned myocardium in chronically instrumented dogs is enhanced by halothane or isoflurane. Anaesthesiology 1988; 69: 552–565.Google Scholar
Kehl F, Pagel PS, Krolidowski JGet al. Isoflurane does not produce a second window of preconditioning against myocardial infarction in vivo. Anaesth Analg 2002; 95: 1162–1168.Google Scholar
Tanaka K, Ludwig LM, Krolidowski JGet al. Isoflurane produces delayed preconditioning against myocardial ischemia and reperfusion injury. Anaesthesiology 2004; 100: 525–531.Google Scholar
Schwartz LM, Sebbag L, Jennings RB, Reimer KA. Duration and reinstatement of myocardial protection against infarction by ischemic preconditioning in open chest dogs. J Mol Cell Cardiol 2001; 33: 1561–1570.Google Scholar
Grover GJ, Garlid KD. ATP-sensitive potassium channels: a review of their cardioprotective pharmacology. J Mol Cell Cardiol 2000; 32: 677–695.Google Scholar
Tanaka K, Kehl F, Gu Wet al. Isoflurane-induced preconditioning is attenuated by diabetes. Am J Physiol Heart Circ Physiol 2002; 282: H2018–H2023.Google Scholar
Sandhy R, Diaz RJ, Mao GD, Wilson GJ. Ischemic preconditioning: differences in protection and susceptibility to blockade with singlecycle versus multicycle transient ischemia. Circulation 1997; 96: 984–995.Google Scholar