Sevoflurane, propofol and carvedilol block myocardial protection by limb remote ischemic preconditioning

Youn Joung Cho, Karam Nam, Tae Kyong Kim, Seong Woo Choi, Sung Joon Kim, Derek J. Hausenloy, Yunseok Jeon

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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.

Original languageEnglish
Article number269
JournalInternational Journal of Molecular Sciences
Volume20
Issue number2
DOIs
StatePublished - 2 Jan 2019

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Ischemic Preconditioning
preconditioning
anesthesia
Propofol
limbs
Surgery
Extremities
Anesthesia
Myocardial Infarction
surgery
Thoracic Surgery
Rats
Dialysis Solutions
Plasmas
Healthy Volunteers
cuffs
ischemia
sevoflurane
carvedilol
Economic Inflation

Keywords

  • Cardiac surgery
  • Cardioprotection
  • Carvedilol
  • Ischemia-reperfusion injury
  • Ischemic preconditioning
  • Propofol
  • Remote ischemic conditioning
  • Sevoflurane

Cite this

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title = "Sevoflurane, propofol and carvedilol block myocardial protection by limb remote ischemic preconditioning",
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",
author = "Cho, {Youn Joung} and Karam Nam and Kim, {Tae Kyong} and Choi, {Seong Woo} and Kim, {Sung Joon} and Hausenloy, {Derek J.} and Yunseok Jeon",
year = "2019",
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language = "English",
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T1 - Sevoflurane, propofol and carvedilol block myocardial protection by limb remote ischemic preconditioning

AU - Cho, Youn Joung

AU - Nam, Karam

AU - Kim, Tae Kyong

AU - Choi, Seong Woo

AU - Kim, Sung Joon

AU - Hausenloy, Derek J.

AU - Jeon, Yunseok

PY - 2019/1/2

Y1 - 2019/1/2

N2 - 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.

AB - 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.

KW - Cardiac surgery

KW - Cardioprotection

KW - Carvedilol

KW - Ischemia-reperfusion injury

KW - Ischemic preconditioning

KW - Propofol

KW - Remote ischemic conditioning

KW - Sevoflurane

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U2 - 10.3390/ijms20020269

DO - 10.3390/ijms20020269

M3 - Article

C2 - 30641885

AN - SCOPUS:85060034934

VL - 20

JO - International journal of molecular sciences

JF - International journal of molecular sciences

SN - 1661-6596

IS - 2

M1 - 269

ER -