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BJA Advance Access originally published online on November 20, 2007
British Journal of Anaesthesia 2008 100(1):29-35; doi:10.1093/bja/aem321
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sevoflurane but not propofol increases interstitial glycolysis metabolites availability during tourniquet-induced ischaemia–reperfusion

M. Carles1,3,*, J. Dellamonica1,3, J. Roux4, D. Lena1, J. Levraut1, J. F. Pittet4, P. Boileau2 and M. Raucoules-Aime1,3

1 Department of Anaesthesia and Intensive Care
2 Department of Orthopaedic Surgery, Archet Hospital, University of Nice, 151 Route de St Antoine Ginestière, 06202 Nice, France
3 EA 3784 UPRES Aix Marseille University, France
4 Department of Anaesthesia, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA

* Corresponding author. Département d’Anesthésie Réanimation, Hôpital l’Archet, 151 Route de St Antoine Ginestière, 06202 Nice, France. E-mail: carles.m{at}chu-nice.fr

Background: Ischaemia/reperfusion (I/R) is one of the main pathophysiological phenomena involved in the anaesthetic practice. The authors hypothesized that anaesthetic regimens can influence skeletal muscle tolerance to tourniquet-induced I/R that should be reflected by the interstitial metabolite levels of anaerobic glycolysis.

Methods: Microdialysis probes were implanted in three groups of 10 patients each receiving either sevoflurane (SEVO), propofol (PRO), or spinal (SA) anaesthesia (for induction and maintenance). SA group was considered as a control group. Interstitial fluid was obtained during tourniquet-induced I/R and was analysed for interstitial glucose, lactate, pyruvate, and glycerol.

Results: The microdialysis flow rate was 0.5 µl min–1. Compared with the control group, the SEVO group had a higher level of both lactate and pyruvate and an increase in glucose during ischaemia. In contrast, the PRO group had a lower level of pyruvate, resulting in a significant higher increase (eight times from baseline) of the lactate pyruvate ratio. Glucose level remained low in this group. During reperfusion, lactate, pyruvate, and glucose remained at a significantly higher level in the SEVO group. In the PRO group, there was no difference in lactate, pyruvate, and glucose levels compared with the control group. The interstitial level of glycerol exhibits only few and comparable changes during I/R between the groups.

Conclusions: Our results indicate that there is a better availability of interstitial glycolysis metabolites (glucose, lactate, and pyruvate) in the skeletal muscle during ischaemia and reperfusion after sevoflurane exposure than after propofol, suggesting a potential preconditioning effect of sevoflurane on tourniquet-induced skeletal muscle I/R.

Keywords: anaesthetics i. v., propofol; anaesthetics volatile, sevoflurane; metabolism, glucose; metabolism, lactate; muscle skeletal, metabolism


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