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Sevoflurane Provides Preconditioning-Like Cardioprotective Effects on Septic Rat Myocardium
Ryohei Serita, MD; Junya Oshida, MD; Yoshifumi Kotake, MD; Junzo Takeda, MD; Hiroshi Morisaki, MD
Anesthesia, Kasumigaura National Hospital, Tsuchiura, Ibaraki, Japan
INTRODUCTION: There is a growing body of evidence that inhalational anesthesia protects myocardium from ischemia-reperfusion injury (1,2). While sepsis is considered to cause delayed preconditioning (3), it remains unclear if ischemic preconditioning-like effects of anesthetics are able to work in septic myocardium whose performance is already deteriorated. We, therefore, examined the effects of brief exposure of sevoflurane prior to global ischemia on the septic rat myocardium in an isolated working heart model.

METHODS: With our institutional approval, 50 rats (310-350g) were treated with cecal-ligation and perforation (CLP) to develop hyperdynamic septic state for 24 hr before the study (4). The hearts were isolated and perfused at 37°C with Krebs-Heseleit solution in a working mode (preload 12 mmHg, afterload 50 mmHg) for 30 min (Baseline), and randomly assigned to one of two groups: Control (Group C; n = 25) or Sevoflurane group (Group S; n = 25). In the latter group, sevoflurane (2.0%) was administered into the perfusion solution via a vaporizer for 15min before the global ischemia (Pre-ischemia). After 15 min ischemia, all hearts were reperfused with Krebs-Heseleit solution for 30 min (Post-reperfusion). Cardiac output (CO), myocardial oxygen consumption (mVO2), heart rate (HR) and the incidence of arrhythmia were measured at each experimental stage. The data were analyzed using multiple analysis of variance with repeated measures.

RESULTS: At the Pre-ischemia period, sevoflurane caused a significant depression of CO with no changes of mVO2 in septic heart. At the Post-ischemia period, the depression of CO after ischemia was minimized without altering mVO2 and HR in the Group S, accompanied by lower incidence of arrhythmia compared with Group C (8% versus 32%). Footnote for Table: mean±SEM, * P<0.01 versus Group C

CONCLUSIONS: The present data indicate that pretreatment with 2% sevoflurane preserves myocardial function after ischemic insult in septic myocardium.

REFERENCES: 1) Anesthesiology 1999;91:701. 2) Anesth Analg 1994;79:226.3) Am J Respir Crit Care Med 1997;156:1473. 4) J Appl Physiol 1996;80:656.