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The effect of general and regional anaesthesia on ischaemia-reperfusion injury.

We investigated the relative effects of general and regional anaesthesia on oxidative variables in patients who had a pneumatic tourniquet for lower limb surgery. The tourniquet and its release were used an in-vivo model for ischaemia-reperfusion injury. With ethics approval and informed consent, 30 ASA 1-2 patients were randomly allocated to receive general anaesthesia group (n=15) maintained with sevoflurane 2-3% (end-tidal) and nitrous oxide 66% in oxygen, or spinal anaesthesia (n=15) with 2 ml 0.5% heavy bupivacaine. The tourniquet was inflated over the thigh for between 60 and 90 minutes. Venous blood samples were obtained before inflation of the tourniquet and five minutes and 30 minutes after its release. Superoxide dismutase (SOD), malondialdehyde (MDA), lipid hydroperoxide (LHP) and nitrate/nitrate ratio (NOx) were measured spectrophotometrically on each sample and were compared between groups using Student's t-tests. SOD eliminates superoxides, MDA and LHP are products of lipid peroxidation, while NOx is an index of peroxynitite activity, a powerful oxidant (1-5). There were no significant differences in SOD between the groups. However, there were significantly lower concentrations of MDA, LHP and NOx in the GA group at both 5 minutes and 30 minutes after tourniquet release (P<0.05, P<0.01 respectively, Tablel). These findings suggest that general anaesthesia with sevoflurane and nitrous oxide is associated with less oxidative stress (i.e. has greater antioxidant activity) than spinal anaesthesia in this in vivo ischaemia-reperfusion model. Further studies are required to confirm these observations.






Ankara, Turkey


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MDA, LHP and NOx levels of patients before ischaemia and after
tourniquet release

Ischaemia Before ATR
 5 min 30 min

GA Group (n=15) MDA
(nmol/ml) 3.56 [+ or -] 0.67 2.31 [+ or -] 0.48
 LHP ([micro]M HPE) 1.86 [+ or -] 0.49 2.05 [+ or -] 0.54
 NOx (nmol/l) 16.65 [+ or -] 2.52 9.96 [+ or -] 2.25
SA Group (n=15) MDA
(nmol/ml) 3.49 [+ or -] 0.04 5.37 [+ or -] 1.42
 LHP ([micro]M HPE) 1.74 [+ or -] 0.62 3.97 [+ or -] 0.82
 NOx (nmol/l) 16.25 [+ or -] 2.81 19.47 [+ or -] 4.40

Ischaemia ATR

GA Group (n=15) MDA
(nmol/ml) 2.81 [+ or -] 0.54
 LHP ([micro]M HPE) 1.54 [+ or -] 0.36
 NOx (nmol/l) 8.86 [+ or -] 1.06
SA Group (n=15) MDA
(nmol/ml) 6.02 [+ or -] 1.07
 LHP ([micro]M HPE) 5.38 [+ or -] 0.85
 NOx (nmol/l) 24.71 [+ or -] 5.31

GA: general anaesthesia, SA: spinal anaesthesia, ATR; after
tourniquet release, values are mean [+ or -] SD.
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Article Details
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Title Annotation:Correspondence
Author:Izdes, S.; Sepici-Dincel, A.; Gozdemir, M.; Ozkan, Y.; Kanbak, O.
Publication:Anaesthesia and Intensive Care
Geographic Code:7TURK
Date:Jun 1, 2007
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