Protective effect of sevoflurane preconditioning on ischemia-reperfusion injury in patients undergoing reconstructive plastic surgery with microsurgical flap, a randomized controlled trial

Claudia Claroni, Giulia Torregiani, Marco Covotta, Maria Sofra, Alessandra Scotto Di Uccio, Maria E Marcelli, Alessia Naccarato, Ester Forastiere, Claudia Claroni, Giulia Torregiani, Marco Covotta, Maria Sofra, Alessandra Scotto Di Uccio, Maria E Marcelli, Alessia Naccarato, Ester Forastiere

Abstract

Background: In many clinical conditions that involve free flaps and tissue transplantations the possibility of minimizing ischemia-reperfusion injury can be a determinant factor for the success of the surgery itself. We hypothesize that preconditioning with sevoflurane is a protective factor against ischemia-reperfusion injury.

Methods: In this randomized controlled trial, patients ASA I-II undergoing breast reconstruction with deep inferior epigastric perforator flaps were allocated into two groups and analyzed: group BAL included patients who received balanced anesthesia with sevoflurane for 30 min before removal of the flap and throughout the surgery. The TCI group included patients who received a total intravenous anesthesia with propofol and remifentanil. We evaluated regional tissue oximetry at the end of the surgery and at 4, 12 and 20 h after surgery. Other assessed parameters were: blood lactate clearance, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, creatine phosphokinase.

Results: In total 54 patients, twenty-seven per group, were analyzed. There was a significant increase of the average value of regional tissue oximetry measured 4 h after surgery in the BAL group compared to the TCI group: BAL: 84.05 % (8.96 SD); TCI : 76.17 % (12.92 SD) (P = 0.03), but not at the other time frames. The creatine phosphokinase value was significantly lower in the BAL group at the end of surgery, but not at the other time-frames. There were no significant differences in blood levels of other markers.

Conclusions: From our results, the positive preconditioning impact of sevoflurane on ischemia-reperfusion injury in patients undergoing free flap surgery is expressed in the early postoperative hours, but it does not persist in the long-term.

Trial registration: ClinicalTrial.gov identifier: NCT01905501 . Registered July 18, 2013.

Keywords: Free flap; Ischemia reperfusion injury; Near infrared spettroscopy; Preconditioning; Sevoflurane.

Figures

Fig. 1
Fig. 1
Patient disposition
Fig. 2
Fig. 2
Intraoperative data. All data presented as mean (standard deviation). * Significant. MAP: mean arterial pressure. EtCO2: end tidal carbon dioxide. FiO2: fraction of inspired oxygen. SpO2: saturation of peripheral oxygen. HR: heart rate. Bpm: beats per minute. h.: hour of surgery
Fig. 3
Fig. 3
Postoperative data. All data presented as mean (standard deviation). * Significant. rSO2: regional tissue oximetry. MAP: mean arterial pressure. SpO2: saturation of peripheral oxygen. HR: heart rate. Bpm: beats per minute. T0: end of surgery, T1 4 h after surgery, T2: 12 h after surgery, T3: 20 h after surgery

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