Propofol Attenuates Ischemia-Reperfusion Injury in the Isolated Rat Heart

Ko, Seonghoon; Yu, Choon-Won; Doo, A Ram; Choe, Huhn; Chung, Mi Sook; Kwak, Yong-Geun; Chae, Soo‐Wan; Song, He-Shan

doi:10.1097/00000539-199710000-00002

Cited by 52 publications

(39 citation statements)

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“…2,17 Based on work from our lab and others using both simulated models of ischemia reperfusion and studies in patients, [18][19][20][21][22][23][24][25] we postulated that propofol confers cardioprotection when a target range of 4.5-8.9 lg Á mL -1 (25 to 50 mM) is achieved.…”

Section: Résumémentioning

confidence: 99%

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Raedschelders

Laferlita

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Propofol concentrations that produce laboratory-based cardioprotective effects are generally greater than those produced under routine anesthesia during cardiac surgery. It is unknown whether experimental cardioprotective propofol concentrations can routinely be achieved during cardiopulmonary bypass (CPB) using continuous infusion. Methods Twenty-four patients scheduled for primary aortocoronary bypass grafting with CPB were allocated to receive one of three propofol infusion rates; 50, 100, or 150 lg Á kg -1 Á min -1 in an open-label pilot study. Data were described using a line of best fit to derive an experimental clinical maneuver predicted to produce a whole blood concentration of 5 lg Á mL -1 at reperfusion. A predetermined interim analysis of 30 patients who were receiving the derived maneuver in an ongoing study was used to evaluate the maneuver. Cardiac index (CI), systemic vascular resistance index (SVRI), and left ventricular stroke work index (LVSWI) were recorded. Results The infusion rate-concentration curve had an equation of y = 0.215e 0.0279x , where y represents the whole blood concentration and x represents the infusion rate (r 2 = 0.781). The predicted infusion rate to achieve a mean concentration of 5 lg Á mL -1 was 113 lg Á kg -1 Á min -1 . The nearest practical rate is 120 lg Á kg -1 Á min -1 , producing a concentration of 5.39 (1.45) lg Á mL -1 . The values for CI, SVRI, and LVSWI were similar between groups at corresponding time periods. Conclusions An infusion rate of 120 lg Á kg -1 Á min -1 is clinically practical and capable of achieving experimental cardioprotective propofol concentrations at reperfusion. RésuméObjectif Les concentrations de propofol qui provoquent des effets cardioprotecteurs lors des tests de laboratoire sont en ge´ne´ral plus e´leve´es que celles produites sous une anesthe´sie de routine lors d'une chirurgie cardiaque. Nous ne savons pas si des concentrations expe´rimentales cardioprotectrices de propofol peuvent eˆtre atteintes de façon routinie`re pendant la circulation extracorporelle (CEC) avec une perfusion continue. Méthode Vingt-quatre patients devant subir un pontage aortocoronarien avec CEC ont e´te´randomise´s à recevoir l'un des trois vitesses de perfusion de propofol suivantes : 50, 100 ou 150 lgÁkg -1 Ámin -1 dans une e´tude pilote ouverte. Les donne´es ont e´te´de´crites a`l'aide d'une droite de re´gression afin de de´river une manoeuvre clinique expe´rimentale qui devrait produire une concentration de sang total de 5 lgÁmL -1 au moment de la reperfusion. Une

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Section: Résumémentioning

confidence: 99%

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Raedschelders

Laferlita

et al. 2009

Can J Anesth/J Can Anesth

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“…Kokita et al reported that propofol preserved the high-energy phosphates ATP and PCr in their Langendorff rat heart model of hydrogen peroxide-induced myocardial damage. 16 Although some have shown propofol to improve contractility following reperfusion, [13][14][15][16][17] others have shown no effects. 18,19 Reduction of myocardial necrosis by propo-982 CANADIAN JOURNAL OF ANESTHESIA FIGURE Ejection fraction (EF; mean ± SEM) normalized by the baseline (B) for both groups at each time-point (O = occlusion; R = reperfusion; D3 = day three follow-up; D10 = day ten followup).…”

Section: Infarct Ratiomentioning

confidence: 99%

“…15,18 Also, these propofol studies involved induction and/or general anesthesia with different anesthetics, followed by a bolus or infusion of propofol at some specific limited time-point. 13,[15][16][17][18][19] This leads to further confounding variables within the studies as the two different anesthetics are now integrated, making it extremely difficult to interpret the effects of propofol alone.…”

Section: Infarct Ratiomentioning

confidence: 99%

“…11,12 Propofol, an alternative to isoflurane, is a widely used anesthetic that has also been inconsistently reported to offer protective effects against reperfusion injury. [13][14][15][16][17][18][19] The primary mechanism of the cardioprotection associated with isoflurane is thought to be through the activation of adenosine triphosphate (ATP)-sensitive potassium (K ATP ) channels. 2,6,7 This, along with other potential mechanisms, has been studied in a variety of ischemia/reperfusion models; with evidence for the following clinically important endpoints: reduction in infarct volume; 1-3,7-10 improved functional recovery; 4,5 and preservation of ATP.…”

mentioning

confidence: 99%

“…2,6,7 This, along with other potential mechanisms, has been studied in a variety of ischemia/reperfusion models; with evidence for the following clinically important endpoints: reduction in infarct volume; 1-3,7-10 improved functional recovery; 4,5 and preservation of ATP. 4,6 The purported mechanisms of cardioprotection by propofol include oxygen free radical scavenging, 15,16 reductions in Ca 2+ overloading, 15 and increases in coronary flow. 15 Enhanced functional recovery, 13,[15][16][17] as well as reductions in myocardial necrosis, 15 and retention of ATP 16 have all been reported with propofol.…”

mentioning

confidence: 99%

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Similar long-term cardiovascular effects of propofol or isoflurane anesthesia during ischemia/ reperfusion in dogs

Thompson

Wisenberg

Sykes

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To compare the long-term functional and metabolic effects of propofol or isoflurane general anesthesia in a canine model of ischemia/reperfusion. M Me et th ho od ds s: :Using magnetic resonance (MR) techniques, we monitored both regional metabolism ( 31 P MR spectroscopy) and systolic function of the heart ( 1 H MR imaging) throughout a two-hour occlusion of the left anterior descending coronary artery and ten days of reperfusion. Twenty-two beagles were randomized into isoflurane and propofol general anesthesia groups (n = 10, n = 12 respectively). Contrast-enhanced MR imaging was used to measure infarct size (% of left ventricle that was necrotic) and coronary blood flow was determined using radioactively labelled microspheres.R Re es su ul lt ts s: : Cardiac metabolism, as monitored by intracellular pH and high-energy phosphate ratios, was not significantly different between the two groups throughout the protocol. Relative to propofol, isoflurane reduced the depression of left ventricular ejection fraction (EF) during the ischemic period [isoflurane 68.5% ± 4.2%, propofol 58.3% ± 2.0% of baseline (B); P = 0.04], propofol increased the recovery of EF at day three (isoflurane 63.9% ± 4.3%, propofol 74.0% ± 2.5% of B; P = 0.05). By day ten, EF in both groups was similar. Infarct sizes were also similar at day ten (isoflurane 15.7% ± 3.0%, propofol 13.2% ± 2.2%). Normalizing these by the region at risk (volume of tissue with low blood flow during the occlusion) to assess infarct ratios was also not significant (isoflurane 0.58% ± 0.08%, propofol 0.54% ± 0.07%).C Co on nc cl lu us si io on ns s: : There were no significant differences between the two anesthetic groups at day ten, suggesting that any apparent dissimilarities in early cardiovascular effects were short-term only. These results indicate that isoflurane and propofol produce equivalent long-term cardiovascular effects following ischemia/reperfusion. [isoflurane : 68,5 %± 4,2 %, propofol : 58,3 % ± 2,0 % des données de base (B) ; P = 0,04], le propofol a accéléré la récupération de la FE au jour trois (isoflurane : 63,9 % ± 4,3 %, propofol : 74,0 % ± 2,5 % de B ; P = 0,05). Au dixième jour, la FE était similaire dans les deux groupes, de même la taille de l'infarctus (isoflurane : 15,7 % ± 3,0 %, propofol : 13,2 % ± 2,2 %). La normalisation de ces données, selon la région à risque (volume de tissu soumis à un faible débit sanguin pendant l'occlusion), réalisée pour évaluer les ratios d'infarctus n'a pas été significative non plus (isoflurane : 0,58 % ± 0,08 %, propofol : 0,54 % ± 0,07 %). Objectif : Comparer les effets fonctionnels et métaboliques prolongés de l'anesthésie générale avec du propofol ou de l'isoflurane chez un modèle canin d'ischémie/reperfusion. Méthode : Nous avons mesuré, grâce aux techniques d'imagerie par résonance magnétique (IRM), le métabolisme régional (spectroscopie IRM 31P) et la fonction systolique cardiaque (IRM 1H) tout au long d'une occlusion de deux heures de l'artère descendante antérieure et...

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Anesthetic Preconditioning: A New Horizon in Myocardial Protection

Nader¹

2003

Myocardial Protection

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Propofol Attenuates Ischemia-Reperfusion Injury in the Isolated Rat Heart

Abstract: It is important to protect the heart from injury by ischemia and reperfusion. The current study demonstrates that in the isolated rat heart, propofol attenuates mechanical, biochemical, and histological changes causes by ischemia and reperfusion.

Cited by 52 publications

References 25 publications

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Similar long-term cardiovascular effects of propofol or isoflurane anesthesia during ischemia/ reperfusion in dogs

Anesthetic Preconditioning: A New Horizon in Myocardial Protection

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