Comparison of the Effects of Anesthesia Methods on Dynamic Thiol/Disulfide Homeostasis in Patients with Chronic Obstructive Pulmonary Disease Under Surgical Stress

Abstract

Purpose: Chronic Obstructive Pulmonary Disease (COPD) is linked to increased oxidative stress. Changing oxidative stress status due to anesthesia applications may affect surgical stress and the incidence of postoperative complications. This study aims to contrast the impacts of general anesthesia (GA) and spinal anesthesia (SA) on the dynamic thiol-disulfide homeostasis among patients with COPD who are undergoing inguinal hernia surgery. Materials and Methods: According to the 2017 Global Strategy Report for the Diagnosis, Management and Prevention of COPD, patients with airflow obstruction (50%≤FEV1<79%) and FEV1/FVC<0.7% were evaluated. A total of 52 COPD patients, group GA (n=26) and group SA (n=26), scheduled for inguinal hernia surgery were included in this observational study. Blood samples were collected preoperatively and at 24 hours postoperatively. Parameters of thiol/disulfide balance were analyzed. Results: In both group GA and group SA, a decrease in total thiol, native thiol and disulfide values was observed after anesthesia compared to pre-anesthesia. However, only in group SA, the decrease in total thiol (p<0.01) and native thiol (p=0.012) values after anesthesia was statistically significant. The change in other variables was not statistically significant. There was no significant difference between group GA and group SA in the thiol/disulfite variables before and after anesthesia. Conclusion: General and spinal anesthesia methods demonstrated a similar response on dynamic thiol/disulfide homeostasis in COPD patients under surgical stress.

Keywords

• COPD
• disulfide
• oxidative stress
• spinal anesthesia
• thiol

Cerrahi Stres Altındaki Kronik Obstruktif Akciğer Hastalığı Olan Hastalarda Anestezi Yöntemlerinin Dinamik Tiyol/disülfid Dengesine Etkilerinin Karşılaştırılması

Abstract

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH), artan oksidatif stres ile bağlantılıdır. Anestezi uygulamalarına bağlı olarak değişen oksidatif stres durumu, cerrahi stresi ve postoperatif komplikasyon insidansını etkileyebilir. Bu çalışma, inguinal herni operasyonu geçiren KOAH’lı hastalarda genel anestezi (GA) ve spinal anestezinin (SA) dinamik tiyol-disülfid dengesi üzerindeki etkilerini karşılaştırmayı amaçlamaktadır. Araçlar ve Yöntem: KOAH’ın Teşhisi, Yönetimi ve Önlenmesi için 2017 Küresel Strateji Raporuna göre, hava akımı obstrüksiyonu (%50≤FEV 1<%79) ve FEV1/FVC<0.7 olan hastalar değerlendirildi. Bu gözlemsel çalışmaya inguinal herni cerrahisi planlanan, grup GA (n=26) ve grup SA (n=26) olmak üzere toplam 52 KOAH hastası dahil edildi. Preoperatif dönemde ve postoperatif 24. saatte kan örnekleri alındı. Tiyol/disülfid dengesinin parametreleri analiz edildi. Bulgular: Hem grup GA hem de grup SA’da anestezi öncesine göre anestezi sonrasında total tiyol, native tiyol ve disülfid değerlerinde bir azalma gözlendi. Ancak sadece Grup SA’da anestezi sonrası total tiyol (p<0.01) ve nativ tiyol (p=0.012) değerlerinin anestezi öncesi değerlerine göre azalması istatistiksel olarak anlamlıydı. Diğer değişkenlerdeki değişim istatiksel olarak anlamlı değildi. Grup GA ve grup SA arasındaki karşılaştırmalarda anestezi öncesi ve sonrası tiyol/disülfit değişkenlerinde kayda değer bir fark gözlenmedi. Sonuç: Cerrahi stres altındaki KOAH hastalarında genel ve spinal anestezi yöntemleri dinamik tiyol/disülfid dengesi üzerine benzer bir yanıt göstermiştir.

Keywords

• disülfid
• KOAH
• oksidatif stres
• spinal anestezi
• tiyol

References

1. 1. Zinellu E, Zinellu A, Fois AG, Carru C, Pirina P. Circulating biomarkers of oxidative stress in chronic obstructive pulmonary disease: a systematic review. Respir Res. 2016;17(1):150.
2. 2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. Available from: www.goldcopd.org. Accessed December 13, 2022.
3. 3. Sies H, Berndt C, Jones DP. Oxidative Stress. Annu Rev Biochem. 2017;86:715-748.
4. 4. Stevens JL, Feelisch M, Martin DS. Perioperative Oxidative Stress: The Unseen Enemy. Anesth Analg. 2019;129(6):1749-1760.
5. 5. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from: http://goldcopd.org 2017. Accessed June 15, 2017.
6. 6. McGuinness AJA, Sapey E. Oxidative Stress in COPD: Sources, Markers, and Potential Mechanisms. J Clin Med. 2017;6(2):21.
7. 7. Lakhdar R, Denden S, Kassab A, et al. Update in chronic obstructive pulmonary disease: role of antioxidant and metabolizing gene polymorphisms. Exp Lung Res. 2011;37(6):364-375.
8. 8. Barnes PJ. Oxidative Stress in Chronic Obstructive Pulmonary Disease. Antioxidants (Basel). 2022;11(5): 965.

9. 9. López-Armada MJ, Riveiro-Naveira RR, Vaamonde-García C, Valcárcel-Ares MN. Mitochondrial dysfunction and the inflammatory response. Mitochondrion. 2013;13(2):106-118.
10. 10. Fields AC, Divino CM. Surgical outcomes in patients with chronic obstructive pulmonary disease undergoing abdominal operations: An analysis of 331,425 patients. Surgery. 2016;159(4):1210-1216.
11. 11. Johnson AP, Altmark RE, Weinstein MS, Pitt HA, Yeo CJ, Cowan SW. Predicting the Risk of Postoperative Respiratory Failure in Elective Abdominal and Vascular Operations Using the National Surgical Quality Improvement Program (NSQIP) Participant Use Data File. Ann Surg. 2017;266(6):968-974.
12. 12. Senoner T, Schindler S, Stättner S, Öfner D, Troppmair J, Primavesi F. Associations of Oxidative Stress and Postoperative Outcome in Liver Surgery with an Outlook to Future Potential Therapeutic Options. Oxid Med Cell Longev. 2019;3950818.
13. 13. Kundović SA, Rašić D, Popović L, Peraica M, Črnjar K. Oxidative stress under general intravenous and inhalation anaesthesia. Arh Hig Rada Toksikol. 2020;71(3):169-177.
14. 14. Dağlı R, Songur Dağlı S, Nar R. Comparison of thiol/disulfide balance in elective and emergency cesarean sections: a prospective, observational study. Journal of Clinical Obstetrics Gynecology. 2019;29(2):68-76.
15. 15. Senoner T, Velik-Salchner C, Luckner G, Tauber H. Anesthesia-Induced Oxidative Stress: Are There Differences between Intravenous and Inhaled Anesthetics? Oxid Med Cell Longev. 2021;8782387.
16. 16. Karabayırlı S, Keskin EA, Kaya A, et al. Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections. J Res Med Sci. 2015;20(8):739-744.
17. 17. Tanyildiz M, Yetimakman AF, Yazici MU et al. Effect of cardiopulmonary bypass on thiol/disulfide homeostasis in congenital heart surgery. TGKDC. 2023;31(4):454-466.
18. 18. Kazancioglu L, Batcik S, Arpa M, et al. The relationship between intraoperative body temperature and thiol/disulfide balance in geriatric patients undergoing elective transurethral prostate resection surgery with spinal anesthesia. Eur Rev Med Pharmacol Sci. 2023;27(18):8523-8530.
19. 19. Gürü S, Kadı G, Yıldırım Ç, Gökhan Ş, Özhasenekler A, Gürü M, Neşelioğlu S, Erel Ö. Thiol/Disulfide Homeostasis and Ischemia-Modified Albumin Levels in 61 Patients with Hypercapnia: A Case-Control Study. Med Sci Monit. 2023;29:e940674. 20. Songur Dağlı S, Dağlı R. The Effect of Delivery Mode on Thiol-Disulfide Balance in the Umbilical Cord Blood. Ahi Evran Med. J. 2021;5(1):22-27.
20. 21. Erel Ö, Erdoğan S. Thiol-disulfide homeostasis: an integrated approach with biochemical and clinical aspects. Turk J Med Sci. 2020;50(Si-2):1728-1738.
21. 22. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem. 2014;47 (18):326-332.
22. 23. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ (Clinical research ed). 2000;321(7275):1493.
23. 24. Hausman Jr MS, Jewell ES, Engoren M. Regional versus general anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesth Analg. 2015;120(6):1405-1412.
24. 25. Aremu PA, Ajayi AM, Ben-Azu B, Orewole OT, Umukoro S. Spinal and general anesthesia produces differential effects on oxidative stress and inflammatory cytokines in orthopedic patients. Drug Metab Pers Ther. 2021;36(1):17-23.
25. 26. Kaya Uğur B, Pirbudak L, Öztürk E, Balat Ö, Uğur MG. Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study. Turk J Obstet Gynecol. 2020;17(3):186-195.
26. 27. Koksal GM, Sayilgan C, Aydin S, Uzun H, Oz H. The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy. Eur J Anaesthesiol. 2004;21(3):217-220.
27. 28. Kulacoglu H, Ozdogan M, Gurer A, et al. Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair. Bratisl Lek Listy. 2007;108(8):335-339.
28. 29. Rutgers SR, Postma DS, Ten Hacken NH, et al. Ongoing airway inflammation in patients with COPD who do not currently smoke. Thorax. 2000;55(1):12-18.
29. 30. Fratta Pasini AM, Ferrari M, Stranieri C, Vallerio P, Mozzini C, Garbin U, Zambon G, Cominacini L. Nrf2 expression is increased in peripheral blood mononuclear cells derived from mild-moderate ex-smoker COPD patients with persistent oxidative stress. Int J Chron Obstruct Pulmon Dis. 2016 28;(11):1733-1743.