Abstract
Purpose
To determine the effect of epidural anesthesia (EP) on oxygenation of the chronically ischemic limb in patients undergoing aorto-femoral bypass grafting and to assess whether it produces an alteration of lipid peroxidation and antioxidant status following revascularization.
Methods
In this prospective, randomized, single-blinded study 40 ASA II or III patients undergoing elective aorto-femoral bypass grafting were allocated to receive general anesthesia (group GA,n = 20), or epidural + GA (group EP,n = 20) during surgery. Femoral venous blood-gas status, activities of the protecting antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-px), glutathione reductase (GSH-rd), glutathione (GSH) and thiobarbituric acid-reactive substances (TBARS) as a marker of lipid peroxidation were determined in blood samples taken from the femoral vein at different intervals before and after revascularization.
Results
Before the induction of anesthesia in group EP, femoral venous PO2 [mean (standard deviation), 95% confidence interval] increased after achieving an adequate level of blockade by EP extending to the dermatomal level of T6-8 [29.32 (4.6), 26.34–32.30 to 36.29 (4.6), 33.37–39.22 mmHg,P < 0.05]. Femoral venous PO2 was similar in both groups thereafter. In the GA group a significant increase in erythrocyte TBARS was observed immediately after restoration of blood flow when compared with baseline values [221.32 (102), 148.35-294-29 to 337.26 (123) 248.99-425.53 nmol·g−1 hemoglobin,P < 0.01] but not at any other moment. In the EP group TBARS did not increase throughout the study. Within group comparisons revealed no significant differences in GSH, GSH-px, GSH-rd and SOD.
Conclusion
In patients with atherosclerotic aorto-iliac occlusive disease EP may possibly attenuate lipid peroxidation following revascularization but has no effect on antioxidant enzyme activities.
Résumé
Objectif
Déterminer l’effet de l’anesthésie péridurale (AP) sur l’oxygénation du membre soumis à l’ischémie chez les patients qui subissent un pontage aorto-fémoral et évaluer si elle produit une altération de la peroxydation lipidique et de l’état antioxydant à la suite de la revascularisation.
Méthode
Une étude prospective, randomisée et à simple insu a été menée auprès de 40 patients d’état physique ASA II ou III qui devaient subir un pontage aorto-fémoral sous anesthésie générale (groupe AG, n = 20) ou anesthésie péridurale + AG (groupe AP, n = 20). La gazométrie du sang veineux fémoral, les activités des enzymes protecteurs antioxydants superoxyde dismutase (SOD), glutathion peroxydase (GSH-px), glutathion réductase (GSH-rd), glutathion (GSH) et les substances réactives à l’acide thiobarbiturique (SRATB), comme marqueur de la peroxydation lipidique, ont été mesurés dans les échantillons sanguins prélevés de la veine fémorale à différents intervalles avant et après la revascularisation.
Résultats
Avant l’induction de l’AP, la PO2 veineuse fémorale [moyenne (écart type), intervalle de confiance de 95%] s’est élevée après le blocage péridural adéquat s’étendant au niveau du dermatome T6-8 [29,32 (4,6) 26,34-32,30 à 36,29 (4,6) 33,37-39,22 mmHg, P< 0,05]. La PO2 veineuse fémorale a été similaire dans les deux groupes par la suite. Dans le groupe AG, une hausse significative d’érythrocyte SRATB, en comparaison avec les valeurs de base, a été notée immédiatement et seulement après la restauration du débit sanguin [221,32 (102) 148,35-294-29 à 337,26 (123) 248,99-425,53 nmol·g−1 hémoglobine, P < 0,01]. Dans le groupe AP, les SRATB n’ont pas augmenté pendant l’étude. Aucune différence intragroupe significative de GSH, GSH-px, GSH-rd et SOD n’a été notée.
Conclusion
Chez les patients atteints d’occlusion aorto-iliaque, l’AP peut atténuer la peroxydation lipidique à la suite de la revascularisation, mais n’a pas d’effet sur les activités antioxydantes des enzymes.
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Yüceyar, L., Erolçay, H., Konukoglu, D. et al. Epidural anesthesia may attenuate lipid peroxidation during aorto-femoral surgery. Can J Anesth 51, 465–471 (2004). https://doi.org/10.1007/BF03018309
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DOI: https://doi.org/10.1007/BF03018309