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Propofol sedation in total knee replacement

Effects on oxidative stress and ischemia-reperfusion damage

Propofolsedierung bei totalem Kniegelenkersatz

Effekt auf oxidativen Stress und Ischämie-Reperfusion-Schaden

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Abstract

Purpose

This study aimed to show the effect of propofol sedation on oxidative stress and inflammation resulting from ischemia-reperfusion.

Methods

After having obtained written informed consent from the patients and ethics committee approval, 36 patients were randomly allocated to 2 groups: group C, control and group P, propofol. Spinal anesthesia was administered to both groups with 15 mg bupivacaine. Patients in group P received a propofol infusion of 2 mg/kgBW/h and the patients in group C received a placebo infusion in an equal dose. Malondialdehyde (MDA), superoxide dismutase (SOD) and the total antioxidative capacity (TAC) levels were measured in venous blood samples prior to propofol or placebo administration (preischemia T0), 30 min after placing the tourniquet (ischemia T1) and 2 h after deflation of the tourniquet (reperfusion T2). High sensitivity C-reactive protein (hsCRP) and neutrophil levels were measured before propofol was administered (T0) and 12 h after reperfusion (T3).

Results

While serum MDA and SOD levels were significantly higher during the reperfusion period than the preischemic period, TAC levels were found to be low in the control group (p < 0.05). In the propofol group there were no differences between the preischemia-reperfusion periods with respect to MDA, SOD and TAC levels (p > 0.05). The neutrophil and hsCRP levels were observed to be increased to a lesser extent in the propofol group compared to the control group (p < 0.05).

Conclusions

Propofol infusion in addition to spinal anesthesia may reduce oxidative damage and the inflammatory response developing due to the tourniquet in total knee replacement surgery.

Zusammenfassung

Hintergrund

Ziel dieser Studie war es, die Wirkung einer Propofolsedierung auf oxidativen Stress und Entzündung als Folge einer Ischämie-Reperfusion festzustellen.

Methode

Nachdem die Zustimmung der Ethikkommission und die schriftlichen Einwilligungen der Patienten vorlagen, wurden 36 Patienten randomisiert einer der beiden folgenden Gruppen zugewiesen: Gruppe K (Kontrollgruppe), Gruppe P (Propofolgruppe). In beiden Gruppen wurde eine Spinalanästhesie mit 15 mg Bupivacain durchgeführt. Während in der Gruppe P Propofol mit 2 mg/kgKG/h infundiert wurde, wurde der Gruppe K eine äquivalente Placeboinfusion verabreicht. In den venösen Blutproben der Patienten wurden vor der Verabreichung von Propofol oder Placebo (T0, Präischämie), in der 30. Minute der Tourniquet-Ischämie (T1, Ischämie) und 2 h nach der Öffnung des Tourniquets (T2, Reperfusion) die Konzentrationen von Malondialdehyd (MDA), Superoxiddismutase (SOD) und die totale antioxidative Kapazität (TAC) bestimmt. Des Weiteren wurden die Konzentrationen des „high sensitivity“ C-reaktiven Proteins (hsCRP) und der Neutrophilen vor der Verabreichung von Propofol (T0) und 12 h nach der Reperfusion (T3) gemessen.

Ergebnisse

In der Gruppe K waren die Serumkonzentrationen von MDA und SOD in der Reperfusionsphase signifikant höher als in der Präischämiephase, während die TAC-Werte niedriger waren (p < 0,05). In der Gruppe P war kein Unterschied zwischen den MDA- sowie SOD-Konzentrationen und der TAC in der Reperfusionsphase und in der Präischämiephase festzustellen (p > 0,05). Die hsCRP- und Neutrophilenwerte der Gruppe P waren weniger erhöht als die der Gruppe K (p < 0,05).

Schlussfolgerung

Die Verwendung einer Propofolinfusion zusätzlich zur Spinalanästhesie kann in der Chirurgie des totalen Kniegelenkersatzes zur Verringerung der im Zusammenhang mit dem Tourniquet entstehenden oxidativen Schädigungen und der entzündlichen Reaktionen führen.

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References

  1. Kharbanda RK, Peters M, Walton B et al (2001) Ischemic preconditioning prevents endothelial injury and systemic neutrophil activation during ischemia-reperfusion in humans in vivo. Circulation 103:1624–1630

    Article  PubMed  CAS  Google Scholar 

  2. Piper HM, Meuter K, Schäfer C (2003) Cellular mechanisms of ischemia-reperfusion injury. Ann Thorac Surg 75:S644–S648

    Article  PubMed  Google Scholar 

  3. Vinten-Johansen J (2004) Involvement of neutrophils in the pathogenesis of lethal myocardial reperfusion injury. Cardiovasc Res 15:481–497

    Article  Google Scholar 

  4. Frei B (1994) Reactive oxygen species and antioxidant vitamins: mechanisms of action. Am J Med 97:22S–28S

    Article  Google Scholar 

  5. MacKinnon KL, Molnar Z, Lowe D (1999) Measures of total free radical activity in critically ill patients. Clin Biochem 32:263–268

    Article  PubMed  CAS  Google Scholar 

  6. Kampa M, Nistikaki A, Tsaousis V et al (2002) A new automated method for the determination of the Total Antioxidant Capacity (TAC) of human plasma, based on the crocin bleaching assay. BMC Clin Pathol 2:3

    Article  PubMed  Google Scholar 

  7. Schwab R, Eissele S, Brückner UB et al (2004) Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair. Hernia 8:226–232

    Article  PubMed  CAS  Google Scholar 

  8. Yamauchi H, Kobayashi E, Yoshida T et al (1998) Changes in immune-endocrine response after surgery. Cytokine 10:549–554

    Article  PubMed  CAS  Google Scholar 

  9. Murphy PG, Myers DS, Davies MJ et al (1992) The antioxidant potential of propofol (2,6-diisopropylphenol). Br J Anaesth 68:613–618

    Article  PubMed  CAS  Google Scholar 

  10. Mikawa K, Akamatsu H, Nishina K et al (1998) Propofol inhibits human neutrophil functions. Anesth Analg 87:695–700

    PubMed  CAS  Google Scholar 

  11. Chen RM, Wu CH, Chang HC et al (2003) Propofol suppresses macrophage functions and modulates mitochondrial membrane potential and cellular adenosine triphosphate synthesis. Anesthesiology 98:1178–1185

    Article  PubMed  CAS  Google Scholar 

  12. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2:656–659

    Article  PubMed  CAS  Google Scholar 

  13. Koca K, Yurttas Y, Cayci T et al (2011) The role of preconditioning and N-acetylcysteine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery. J Trauma 70:717–723

    Article  PubMed  CAS  Google Scholar 

  14. Stahl GL, Halliwell B, Longhurst JC (1992) Hydrogen peroxide-induced cardiovascular reflexes. Role of hydroxyl radicals. Circ Res 71:295–302

    Article  PubMed  CAS  Google Scholar 

  15. Lin L, Wang L, Bai Y et al (2010) Pulmonary gas exchange impairment following tourniquet deflation: a prospective, single-blind clinical trial. Orthopedics 9:395

    Google Scholar 

  16. Horlocker TT, Hebl JR, Gali B et al (2006) Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty. Anesth Analg 102:950–955

    Article  PubMed  Google Scholar 

  17. Zhang JD, Xia Q, Ji N et al (2013) Transient paralysis shortly after anterior cervical corpectomy and fusion. Orthop Surg 5:23–28

    Article  PubMed  Google Scholar 

  18. Caporaso N (2003) The molecular epidemiology of oxidative damage to DNA and cancer. J Natl Cancer Inst 95:1263–1265

    Article  PubMed  CAS  Google Scholar 

  19. Vinten-Johansen J (2004) Involvement of neutrophils in the pathogenesis of lethal myocardial reperfusion injury. Cardiovasc Res 61:481–497

    Article  PubMed  CAS  Google Scholar 

  20. Parratt JR (1994) Protection of the heart by ischaemic preconditioning: mechanisms and possibilities for pharmacological exploitation. Trends Pharmacol Sci 15:19–25

    Article  PubMed  CAS  Google Scholar 

  21. Prior RL, Cao G (1999) In vivo total antioxidant capacity: comparison of different analytical methods. Free Radic Biol Med 27:1173–1181

    Article  PubMed  CAS  Google Scholar 

  22. Ghiselli A, Serafini M, Natella F, Scaccini C (2000)Total antioxidant capacity as a tool to assess redox status: critical view and experimental data. Free Radic Biol Med 29:1106–1114

    Article  PubMed  CAS  Google Scholar 

  23. Marik PE (2005) Propofol: an immunomodulating agent. Pharmacotherapy 25:28S–33S

    Article  PubMed  CAS  Google Scholar 

  24. Ozkan F, Senayli Y, Ozyurt H et al (2012) Antioxidant effects of propofol on tourniquet-induced ischemia-reperfusion injury: an experimental study. J Surg Res 176:601–607

    Article  PubMed  CAS  Google Scholar 

  25. Uzunköy A, Coskun A, Akinci OF, Kocyigit A (2000) Systemic stress responses after laparoscopic or open hernia repair. Eur J Surg 166:467–471

    Article  PubMed  Google Scholar 

  26. Duilio C, Ambrosio G, Kuppusamy P et al (2001) Neutrophils are primary source of O2 radicals during reperfusion after prolonged myocardial ischemia. Am J Physiol Heart Circ Physiol 280:2649–2657

    Google Scholar 

  27. Dreyer WJ, Michael LH, West MS et al (1991) Neutrophil accumulation in ischemic canine myocardium. Insights into time course, distribution, and mechanism of localization during early reperfusion. Circulation 84:400–411

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Anaesthesia, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Koru M Kavakli S No:4/44, 06810, Ankara, Turkey

    D. Özkan MD, T. Akkaya & H. Gümüs

  2. Department of Biochemistry, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    A. Yalcindag, T. Hanci & N. Delibas

  3. Department of Orthopaedics and Traumatology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    E. Gönen

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  1. D. Özkan MD
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  2. T. Akkaya
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  4. T. Hanci
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Correspondence to D. Özkan MD.

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Özkan, D., Akkaya, T., Yalcindag, A. et al. Propofol sedation in total knee replacement. Anaesthesist 62, 537–542 (2013). https://doi.org/10.1007/s00101-013-2192-8

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  • DOI: https://doi.org/10.1007/s00101-013-2192-8

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