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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.

S. IZDES

A. SEPICI-DINCEL

M. GOZDEMIR

Y. OZKAN

O. KANBAK

Ankara, Turkey

References

(1.) Gutteridge JMC. Biological origin of free radicals and mechanisms of antioxidant protection. Chemico Biological Interactions 1994; 91: 133-140.

(2.) Hammouda AE, Soliman SF, Tolba KA, el-Kabbany ZA, Makhlouf MS. Plasma concentrations of lipid peroxidation products in children with acute lymphoblastic leukemia. Clin Chem 1992; 38:594-595.

(3.) Nourooz-Zadeh J. Ferrous ion oxidation in presence of xylenol orange for detection of lipid hydroperoxides in plasma. Methods Enzymol 1999; 300:58-62.

(4.) Sun Y, Oberley LW, Li Y. A simple method for clinical assay of superoxide dismutase. Clin Chem 1988; 34: 497-500.

(5.) Miranda KM, Espey MG, Wink DA. A rapid, simple spectrophotometric method for simultaneous detection of nitrate and nitrite. Nitric Oxide 2001; 5: 62-71.
TABLE 1
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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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
Words:558
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