Effect of etomidate on the oxidative stress response and levels of inflammatory factors from ischemia-reperfusion injury after tibial fracture surgery

Abstract

The effect of etomidate on the oxidative stress response and levels of inflammatory factors resulting from ischemia-reperfusion injury of the lower extremities during tibial fracture surgery were investigated. From December 2013 to June 2015, 60 tibial fracture patients with surgical indications for open reduction and internal fixation were selected. Patients were randomly divided into the observation group and the control group. All patients were stanched by tourniquet hemostasis. Patients in the observation group were anesthetized with etomidate (3–6 mg/kg·h) + remifentanil (0.1–0.25 µg/kg/min) administered with an injection pump to maintain intraoperative sedation and analgesia anesthesia. Patients in the control group received propofol (3–6 mg/kg·h) + remifentanil (0.1–0.25 µg/kg/min). Before surgery (T0), before surgery was completed and anesthesia was stopped (T1), 24 h after surgery (T3), 48 h after surgery (T4), and 1 week after surgery (T5), serum superoxide dismutase (SOD) activity was determined with a kit, and ELISA was used to measure the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 in peripheral blood from both groups of patients. Surgery in both groups was completed smoothly. We found that serum SOD levels of patients in the observation group were significantly higher than those of the control group, while the levels of TNF-α, IL-1, and IL-6 released by neutrophils were significantly decreased after ischemia-reperfusion injury (P<0.05). Postoperative length of stay in hospital of the observation group was significantly shorter and the occurrence rate of anesthesia complications was significantly lower than in the control group (P<0.05). In conclusion, during surgery for lower limb fracture, the use of etomidate for maintaining sedation can effectively maintain serum SOD activity and inhibit the release of inflammatory factors after ischemia-reperfusion injury of the fracture, to reduce the occurrence rate of anesthesia complications after surgery.

The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis

“…One study in emergency orthopedic surgery ( n = 60), reported a significant reduction of the mean peak IL-6 in patients given TIVA using etomidate versus TIVA with propofol (3240 pg/mL versus 9000 pg/mL, P = .001) [27] . It should be noted that etomidate inhibits the conversion of 11-deoxycortisol to cortisol resulting in transient HPA axis suppression.…”

“… CRP 24 h TIVA + DEX group, 24 h, CRP = 150 mg/L TIVA group, 24 h, CRP = 120 mg/L No significant difference between groups. [27] China Tibial fracture surgery. Moderate 60 Control group = patients received propofol with remifentanil.…”

Effects of cyclosporin A pre-treatment combined with etomidate post-treatment on lung injury induced by limb ischemia-reperfusion in rats

“… 24 Some studies have shown that ETO pre-treatment can reduce the expression of Bax protein during LILIR in rats, mediating a protective effect. 17 ETO may play a protective role in reperfusion injury by activating gamma-aminobutyric acid receptors, increasing the permeability of the cell membrane to Cl ions and preventing depolarization the cell membrane. 25 In addition, the N-methyl-D-aspartate receptor and the Ca 2+ -channel are voltage dependent; inhibition of cell membrane depolarization leads to decreased Ca 2+ influx and decreased cellular oxygen consumption.…”

“…15,16 Fas and its ligand FasL have been thoroughly studied with a profound impact on our understanding of the mechanisms of apoptosis. [17][18][19] CsA is a cyclic peptide comprising 11 amino acids. It is an active metabolite of fungi in soil and has strong immunosuppressive effects.…”

Microcirculatory consequences of limb ischemia/reperfusion in ovariectomized rats treated with zoledronic acid

“…Proinflammatory cytokines (e.g. TNF-alpha, IL-1 and IL-6) typically reach peak values after fracture operations [5], and it is suggested that these proinflammatory reactions may critically influence the process of bone regeneration.…”