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