SEVOFLURANE AND DESFLURANE. DIFFERENT EFFECTS ON OXIDATIVE PARAMETERS IN ISCHEMIA-REPERFUSION INJURY

摘要

In this study were investigated the effects of sevoflurane and desflurane on the serum oxidative stress parameters. The model consisted in verifying the oxidative stress difference between sevoflurane and desflurane anaesthetics in ischemia/reperfusion of human skeletal muscle in which sevoflurane, used during the orthopaedic surgery with tourniquet, might be more protective to the reperfusion injury of tissues. Reactive oxygen species are considered to be important components involved in the pathophysiological tissue alterations observed during ischemia and reperfusion. In this study the time-dependent differences in antioxidant enzyme activities and free radicals in ischemia/reperfusion injury model were discussed using tourniquet during the elective unilateral knee arthroplasty. Twenty-eight patients, ASAI-II, were included in the study. The anaesthesia induction was achieved with lidocaine, thiopental sodium, cisatracurium besylate and 1 ug/kg fentanyl following pre-oxygenisation for 3 min. The anaesthesia maintenance was provided with 50% N2O, 50% O2 and 1 minimum alveolar concentration of sevoflurane or desflurane by controlled ventilation. Pneumatic tourniquet was applied after blood samples were taken from the femoral vein and following placement of total knee prothesis, reperfusion was provided by getting down the tourniquet and blood samples were also obtained at 5, 20, 60 min and in 24 h. In the desflurane group, malondialdhyde levels increased (p<0.05) during 24 h and superoxide dismutase levels were decreased during the first 20 min of reperfusion while there were no differences in the sevoflurane group. Sixty minutes after initiation of reperfusion, total antioxidant status decreased in the sevoflurane group (p<0.05). Both inhalation anaesthetics had advantages and disadvantages depending on their antioxidant capacities and free radical scavenging abilities. While deciding on the anaesthesia protocol, needs and potential side effects affecting the postoperative period and wellness of the patients could be the priority.