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Nowiny Lekarskie 2006, 75, 3, 237–239

KRZYSZTOF KUSZA1, UFUK NALBANTOGLU2, MARIA SIEMIONOW3

SEVOFLURANE ANAESTHESIA IMPROVES MICROCIRCULATORY HAEMODYNAMICS


OF THE MUSCLE FLAP. PRELIMINARY STUDY

POPRAWA HEMODYNAMIKI MIKROKRĄŻENIA W PŁACIE MIĘŚNIOWYM


PO ZNIECZULENIU SEVOFLURANEM. BADANIA WSTĘPNE
1
Nicolaus Copernicus University, Toruń, Collegium Medicum, Bydgoszcz
Chair and Department of Anesthesiology and Intensive Therapy
Head of Chair and Department: Krzysztof Kusza MD, PhD, DSc
Poznan University of Medical Sciences
2
Department of Anesthesiology and Intensive Therapy and Pain Management
University of Utah College of Medicine
Division of Plastic and Reconstructive Surgery, Salt Lake City, Utah
Head: Ufuk Nalbantoglu
3
The Cleveland Clinic Foundation, Department of Plastic and Reconstructive Surgery, Cleveland, Ohio
Head: Maria Siemionow MD, PhD, DSc

Summary
Introduction and aim of study. Despite the advances in reconstructive microsurgery, the failure rate of free tissue transfers is still exceed-
ing 10–15%. We postulate that the survival rate of free tissue transfers may be directly depend on effects of anaesthetic agents expressed at
microcirculatory level. Because the effects of sevoflurane on skeletal muscle microcirculation are not well recognized, this study was dedi-
cated to evaluate peripheral microcirculatory haemodynamics under sevoflurane anaesthesia using an intravital microscopic study.
Material and methods. Twenty two Sprague-Dawley rats were observed in three groups. Group I – control (n = 6): Following induction
of anaesthesia with penthobarbital (40 mg/kg ip), rats were intubated and anaesthesia was maintained with 1.5 MAC sevoflurane and
mechanical ventilation with FiO2 = 0.35. The following vital parameters were measured: MAP, CVP, EKG, pH, PaCO2, PaO2 and oeso-
phageal temperature. Group II – pentobarbital anaesthesia (n = 8): Following induction with pentobarbital (Nembutal 40 mg/kg) the drug
was administered intraperitoneally. Vital parameters were measured like in group I. Group III – sevoflurane anaesthesia (n = 8): Following
induction as above, lung ventilation was maintained with 1.5 MAC of sevoflurane and FiO2 = 0.35. In groups II and III the cremaster
muscle flap was isolated on the neurovascular pedicle and prepared in tissue bath for intravital microscopy.
Results and conclusions. Sevoflurane anaesthesia improved flow haemodynamics observed at peripheral microcirculation. Sevoflurane
anaesthesia was maintained 1h before cremaster muscle isolation and we suspect protective effect of sevoflurane on cremaster muscle
flow haemodynamics after surgical isolation as a preconditioning effect.
KEY WORDS: microcirculation, general anaesthesia, inhalation anaesthetic agents, sevoflurane.

Streszczenie
Wstęp i cel pracy. Zabiegi związane z rekonstrukcją lub przenoszeniem wolnych płatów mięśniowych są czasochłonne, a niepowodzenia
po ich przeprowadzeniu sięgają nadal 15%. Technika znieczulenia może mieć bezpośredni wpływ na właściwy przepływ krwi w przeniesio-
nym lub w wolnym płacie mięśniowym. Z tego powodu celem pracy jest ocena wpływu znieczulenia ogólnego z zastosowaniem sevoflura-
nu na podstawowe parametry dynamiki mikrokrążenia w wolnym płacie mięśniowym przy użyciu mikroskopii świetlnej sprzężonej
z optycznym doplerowskim miernikiem prędkości przepływu krwinek czerwonych w warunkach in vivo.
Materiał i metoda. 22 szczury rasy Sprague-Dawley poddano analizie w 3 grupach eksperymentalnych. Grupa I – kontrolna (n = 6). Po
indukcji znieczulenia z zastosowaniem pentobarbitalu dootrzewnowo znieczulenie podtrzymywano przy użyciu 1,5 MAC sevofluranu.
Dokonywano pomiaru następujących parametrów życiowych: MAP, CVP, EKG, pH, PaCO2, PaO2 oraz temperatury w przełyku. Grupa II –
znieczulenie pentobarbitalem (n = 8). Znieczulenia dokonywano przez podanie pentobarbitalu dootrzewnowo. Parametry życiowe poddane
zostały analizie jak w grupie I. Grupa III – znieczulenie sewofluranem (n = 8). Po indukcji znieczulenia jak w grupie II znieczulenie ogólne
było podtrzymywane z zastosowaniem 1,5 MAC sewofluranu. W grupie II i III dokonywano mikrochirurgicznej izolacji mięśnia dźwigacza
jądra wraz pęczkiem nerwowo-mięśniowym celem przyżyciowej obserwacji następujących parametrów mkrokrążenia: aktywności leukocy-
tów i limfocytów w żyłce pozawłośniczkowej, prędkości przepływu krwinek czerwonych i liczby poddanych przepływowi krwi naczyń
włosowatych.
Wyniki. W grupie pentobarbitalu obserwowano statystycznie znamienny wzrost aktywności leukocytów i limfocytów w porównaniu do
grupy sewofluranu, co zostało potwierdzone przez zwiększoną liczbę leukocytów przylegających do śródbłonka (41,2%) p < 0,01, toczących
się leukocytów (76,8%) p < 0,001), toczących się limfocytów (87,9%) p < 0,001) i przedostających się przez śródbłonek na zewnątrz naczy-
nia leukocytów (39,8%) p < 0,05. W grupie pentobarbitalu zanotowano znamienny wzrost współczynnika obrzęku śródbłonka (19,3%) p <
0,05). W grupie sewofluranu znamiennie wzrosła liczba poddanych przepływowi krwi naczyń włosowatych (28,7%) p < 0,01.
Wnioski. Znieczulenie ogólne z zastosowaniem sewofluranu sprzyja poprawie dynamiki mikrokrążenia poprzez zwiększenie przepływu
krwi w wolnym płacie mięśniowym. Zastosowanie sewofluranu na 1 godzinę przed chirurgiczną izolacją mięśnia mogło być przyczyną jego
protekcji podczas czynności chirurgicznych odpowiedzialnych zwykle za zjawisko niedokrwienia i reperfuzji.
SŁOWA KLUCZOWE: mikrokrążenie, znieczulenie ogólne, anestetyki wziewne, sewofluran.
238 Krzysztof Kusza et al.

ties (RBC velocities) using optical Doppler velocimeter,


Introduction capillary density measured in 27 fields, leukocytes and
Despite advances in reconstructive microsurgery, the lymphocytes activation (rolling, sticking and transmi-
failure rate of free tissue transfers is still exceeding 10– grating white blood cells (WBC) in postcapillary ve-
15%. The factors responsible to flap failure are following: nules), and endothelial oedema index.
microembolic and microthrombotic events that result in
local hypoxia, blood hypoxaemia and tissue acidosis, dis- Results
turbances in mean arterial pressure and in blood volume and During pentobarbital anaesthesia, significant activa-
leukocytes sticking and transmigrating at the microcircula- tion of leukocytes and lymphocytes was observed. It was
tory level. Recent studies proved haemodynamic effects of confirmed by an increase in the number of adherent
volatile anaesthetics agent on microcirculatory level. Clini- leukocytes (41.2%) (p < 0.01), rolling leukocytes (76.8%)
cal and experimental investigations documented the pattern (p < 0.001), rolling lymphocytes (87.9%)(p < 0.001) and
of gross microcirculatory flow in heart muscle, brain, gut, transmigrating WBC (39.8%) (p < 0.05). In addition
skin, and other vital organs. It is not clear and well recog- endothelial oedema index expressing occlusion of post-
nized, if any anaesthetic agents may alter or improve micro- capillary venules increased by 19.3% in the barbiturate
circulatory responses during complex microsurgical proce- group (p < 0.05). During sevoflurane anaesthesia im-
dures where patients are often exposed to the effects of provement in flow haemodynamics was confirmed by
prolonged anaesthesia. We postulate that the survival rate of 44% increase in capillary perfusion in the entire muscle
free tissue transfers may directly depend on effects of flap (p < 0.01). RBC velocity was higher in sevoflurane
anaesthetic agents expressed at microcirculatory level. The group (28.7%) as compared to pentobarbital group (p <
rat cremaster muscle flap model allows for direct evaluation 0.05). Surprisingly, in the same time vascular diameters
of capillary perfusion and microvessel reactivity and re- in postcapillary venules increased in sevoflurane group
sponses to different pharmacological agents. Because the (21%) (p < 0.05) despite the Poiseuille principle.
effects of sevoflurane on skeletal muscle microcirculation
are not well recognized or established, this study was dedi- Conclusion
cated to evaluate peripheral microcirculatory haemodynam- In this study the harmful effect of barbiturate anaes-
ics under sevoflurane anaesthesia using an intravital micro- thesia was confirmed by significant increase in leukocytes
scope. activation, endothelial oedema index, and parenchymal
cell damage. In contrast, during sevoflurane anaesthesia
Materials and methods improved flow haemodynamics were observed at peri-
The rat cremaster muscle flap model was prepared pheral microcirculation. A significant increase in capillary
for intravital microscopy study. Twenty two Sprague- density and sevoflurane inhalation anaesthesia resulted in
Dawley rats were observed in three groups. enhanced perfusion of muscle flap.
Group I-control (n = 6): Following induction of
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