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Int J Mol Sci. 2019 Jan 11;20(2). pii: E269. doi: 10.3390/ijms20020269.

Sevoflurane, Propofol and Carvedilol Block Myocardial Protection by Limb Remote Ischemic Preconditioning.

Cho YJ1, Nam K2, Kim TK3,4, Choi SW5,6, Kim SJ7, Hausenloy DJ8,9,10,11,12,13, Jeon Y14.

Author information

1
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea. mingming7@gmail.com.
2
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea. karamnam@gmail.com.
3
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea. ktkktk@gmail.com.
4
Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea. ktkktk@gmail.com.
5
Department of Physiology, Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea. djmaya@snu.ac.kr.
6
Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul 05029, Korea. djmaya@snu.ac.kr.
7
Department of Physiology, Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea. physiolksj@gmail.com.
8
Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore. d.hausenloy@ucl.ac.uk.
9
Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College of London, London WC1E 6HX, UK. d.hausenloy@ucl.ac.uk.
10
Tecnologico de Monterrey, Centro de Biotecnologica-FEMSA, Nuevo Leon 64849, Mexico. d.hausenloy@ucl.ac.uk.
11
Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore. d.hausenloy@ucl.ac.uk.
12
The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London W1T 7DN, UK. d.hausenloy@ucl.ac.uk.
13
National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore. d.hausenloy@ucl.ac.uk.
14
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea. jeonyunseok@gmail.com.

Abstract

The effects of remote ischemic preconditioning (RIPC) in cardiac surgery have been inconsistent. We investigated whether anesthesia or beta-blockers interfere with RIPC cardioprotection. Fifty patients undergoing cardiac surgery were randomized to receive limb RIPC (four cycles of 5-min of upper arm cuff inflation/deflation) in the awake state (no-anesthesia; n = 17), or under sevoflurane (n = 17) or propofol (n = 16) anesthesia. In a separate crossover study, 11 healthy volunteers received either carvedilol or no medication prior to RIPC. Plasma dialysates were obtained and perfused through an isolated male Sprague⁻Dawley rat heart subjected to 30-min ischemia/60-min reperfusion, following which myocardial infarct (MI) size was determined. In the cardiac surgery study, pre-RIPC MI sizes were similar among the groups (39.7 ± 4.5% no-anesthesia, 38.9 ± 5.3% sevoflurane, and 38.6 ± 3.6% propofol). However, post-RIPC MI size was reduced in the no-anesthesia group (27.5 ± 8.0%; p < 0.001), but not in the anesthesia groups (35.7 ± 6.9% sevoflurane and 35.8 ± 5.8% propofol). In the healthy volunteer study, there was a reduction in MI size with RIPC in the no-carvedilol group (41.7 ± 4.3% to 30.6 ± 8.5%; p < 0.0001), but not in the carvedilol group (41.0 ± 4.0% to 39.6 ± 5.6%; p = 0.452). We found that the cardioprotective effects of limb RIPC were abolished under propofol or sevoflurane anesthesia and in the presence of carvedilol therapy.

KEYWORDS:

cardiac surgery; cardioprotection; carvedilol; ischemia-reperfusion injury; ischemic preconditioning; propofol; remote ischemic conditioning; sevoflurane

PMID:
30641885
PMCID:
PMC6359553
DOI:
10.3390/ijms20020269
[Indexed for MEDLINE]
Free PMC Article

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