The effect of minimal-flow and high-flow hypotensive anesthesia on oxidative stress

Year 2021, Volume: 7 Issue: 2, 221 - 229, 31.08.2021

Şule Batçık Leyla Kazancıoğlu Medeni Arpa İlkay Bahçeci Özcan Erel

https://doi.org/10.19127/mbsjohs.936739

Cited By: 2

Abstract

Objective: The main objective of this study was to compare the effects of minimal and high gas flow-controlled hypotension applications on IMA and thiol/disulfide balance, which are indicators of oxidative stress.

Methods: Patients undergoing elective tympanoplasty were randomized to two groups as minimal-flow and high-flow anesthesia groups. Minimal flow anesthesia was performed with 5L/min fresh gas flow reduced to 0.4 L/min. High flow was administered as 2 L/min fresh gas. Preoperative and intraoperative SpO2, StO2, EtCO2, mean arterial pressure and heart rate values were recorded. Preoperative and intraoperative IMA, total thiol, native thiol, disulfide, disulfide/native thiol and disulfide/total thiol values were recorded and compared between the two groups.

Results: The mean intraoperative arterial pressure was statistically notably higher in the high flow group (p=0.048). The mean intraoperative SPO2 value was remarkably higher in the minimal flow group (p=0.032). The mean EtCO2 value was notably lower in the minimal flow group at 5 minutes and 15 minutes of the operation (p=0.029; p=0.048). The mean preoperative and intraoperative IMA values were statistically notably higher in the minimal flow group compared to the high flow group (for both, p=0.001). There was no remarkable difference between the groups in terms of the other monitored parameters (for all, p>0.05).

Conclusion: IMA value was found to be significantly higher with minimal-flow anesthesia. However, no notable difference was found in terms of thiol/disulfide homeostasis, indicating the need for further comprehensive studies in order to draw a definitive conclusion

Keywords

minimal flow, high flow, anesthetics, oxidative stress, thiols

References

• 1. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs. 2007;67(7):1053-1076.
• 2. Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol. 1990;247(2):63-76.
• 3. Felfernig-Boehm D, Salat A, Kinstner C, et al. Influence of hypotensive and normotensive anesthesia on platelet aggregability and hemostatic markers in orthognathic surgery. Thromb Res. 2001;103(3):185-192.
• 4. Sanad HA, Mohamed AZ, Abd-elraouf AA. Comparative study between three Different Doses of Magnesium Sulfate as a Technique of Hypotensive Anesthesia during Functional Endoscopic Sinus Surgery. Egypt. J. Hosp. Med. 2019; 74 (8): 1759-1768.
• 5. 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 [published online ahead of print, 2020 Oct 7]. Drug Metab Pers Ther. 2020;/j/dmdi.ahead-of-print/dmdi-2020-0134/dmdi-2020-0134.xml.
• 6. 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.
• 7. Brattwall M, Warrén-Stomberg M, Hesselvik F, Jakobsson J. Brief review: theory and practice of minimal fresh gas flow anesthesia. Can J Anaesth. 2012;59(8):785-797.
• 8. March PA, Muir WW. Bispectral analysis of the electroencephalogram: a review of its development and use in anesthesia. Vet Anaesth Analg. 2005; 32(5):241-255 9. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem. 2014;47(18):326-332.
• 10. Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med. 2000;19(4):311-315.
• 11. Jiang J, Zhou R, Li B, Xue F. Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials. J Orthop Surg Res. 2019;14(1):409.
• 12. Barak M, Yoav L, Abu el-Naaj I. Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: a review of the literature. ScientificWorldJournal. 2015;2015:480728.
• 13. Stevens JL, Feelisch M, Martin DS. Perioperative Oxidative Stress: The Unseen Enemy. Anesth Analg. 2019;129(6):1749-1760.
• 14. Bito H. “Metabolism and toxicity of anesthetics,” Masui. The Japanese Journal of Anesthesiology, 1999; 48:172–179.
• 15. Song BC, Joo NS, Aldini G, Yeum KJ. Biological functions of histidine-dipeptides and metabolic syndrome. Nutr Res Pract. 2014;8(1):3-10.
• 16. Sanders LH, Timothy Greenamyre J. Oxidative damage to macromolecules in human Parkinson disease and the rotenone model. Free Radic Biol Med. 2013;62:111-120.
• 17. Wilson JX, Gelb AW. Free radicals, antioxidants, and neurologic injury: possible relationship to cerebral protection by anesthetics. J Neurosurg Anesthesiol. 2002;14(1):66-79.
• 18. Kevin LG, Novalija E, Stowe DF. Reactive oxygen species as mediators of cardiac injury and protection: the relevance to anesthesia practice. Anesth Analg. 2005;101(5):1275-1287.
• 19. Allaouchiche B, Debon R, Goudable J, Chassard D, Duflo F. Oxidative stress status during exposure to propofol, sevoflurane and desflurane. Anesth Analg. 2001;93(4):981-985.
• 20. Kotani N, Takahashi S, Sessler DI, et al. Volatile anesthetics augment expression of proinflammatory cytokines in rat alveolar macrophages during mechanical ventilation. Anesthesiology. 1999;91(1):187-197.
• 21. Taşkın D, Gedik E, Kayhan Z. Effects of Minimal Flow Sevoflurane or Desflurane Anaesthesia on Hemodynamic Parameters, Body Temperature and Anaesthetic Consumption. Turk J Anaesthesiol Reanim. 2020;48(5):356-363.
• 22. Ceylan A, Kırdemir P, Kabalak A, Aksu C, Baydar M, Göğüş N. Düşük akım desfluran ve sevofluran anaestezisinde karboksihemoglobin, hemodinami ve uyanma kriterlerinin karşılaştırılması [Turkish Article]. Gülhane Tıp Dergisi 2004; 46: 291-7.
• 23. Baum JA. Low-flow anesthesia: theory, practice, technical preconditions, advantages, and foreign gas accumulation. J Anesth. 1999;13(3):166-174.
• 24. Kilic F, Avci O, Duger C, et al. Evaluation of Low and High Flow Anesthesia Methods Effects on Perioperative Hemodynamics, Depth of Anesthesia and Postoperative Recovery in Patients Unadergoing Abdominal Surgery. J Anesth Surg 2018; 5(1): 41- 47
• 25. Jena I, Nayak SR, Behera S, et al. Evaluation of ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic stroke patients. J Nat Sci Biol Med. 2017;8(1):110-113.
• 26. Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart. 2006;92:113–4.
• 27. Sonmez MG, Kozanhan B, Deniz ÇD, et al. Is oxidative stress measured by thiol/disulphide homeostasis status associated with prostate adenocarcinoma?. Cent Eur J Immunol. 2018;43(2):174-179.