The effects of isoflurane anesthesia and mechanical ventilation on renal function during endotoxemia
The effects of isoflurane anesthesia and mechanical ventilation on renal function during endotoxemia
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DOI：
10.1111/j.1399-6576.2011.02406.x
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发表时间：
2011-04-01
影响因子：
2.1
通讯作者：
Rundgren, M.
中科院分区：
文献类型：
--
作者：
Frithiof, R.;Soehnlein, O.;Rundgren, M.
背景：二氟醚是一种常用的麻醉剂，用于人体手术和脓毒症动物模型。它被认为具有有益的抗炎特性和保护肾脏功能。在这里，我们研究了异氟醚在48小时内毒素血症期间对绵羊肾脏损伤和功能障碍的影响。方法在实验前，16只羊在肾动脉、股动脉和肠系膜上动脉周围置入瞬时血流探头。动物被随机分为两组，一组用异氟醚麻醉并机械通气，另一组在静脉注射大肠杆菌脂多糖（LPS） 48小时（25 ng/kg/min）时保持清醒。在每组的两只动物中，LPS被排除在外，以研究异氟烷本身随时间的任何影响。结果多毒血症引起高动力脓毒症典型的心血管改变，两组患者均出现肾充血，但肾功能受损。与清醒动物相比，异氟醚显著（P < 0.05）降低了内毒素血症时的尿量、肾肌酐清除率、部分钠排泄和肾血流量。此外，麻醉动物血浆尿素和肌酐浓度增加较多。异氟醚麻醉也增强了内毒素血症期间肾脏中中性粒细胞的活性和积累。n -乙酰- β -d-氨基葡萄糖酶显著升高，作为肾小管损伤的指征，组间无差异。结论本研究结果提示，异氟醚麻醉（肺泡最低浓度1.0）加机械通气可加重内毒素血症48小时内的肾功能障碍，并不能显著减少炎症反应或肾小管损伤的迹象。
BackgroundIsoflurane is a common anesthetic agent used in human surgery and in animal models of sepsis. It has been suggested to have beneficial anti-inflammatory properties and to protect kidney function. Here, we investigated the effect of isoflurane on the development of kidney injury and dysfunction during 48-h endotoxemia in sheep.MethodsBefore the experiments, the sheep (n=16) were surgically equipped with transit-time flowprobes around the renal, femoral and superior mesenteric artery. The animals were randomized to either be anesthetized with isoflurane and mechanically ventilated or to remain conscious while they received intravenous Escherichia coli lipopolysaccharide (LPS) for 48 h (25 ng/kg/min). In two animals in each group, the LPS was excluded to investigate any effect of isoflurane per se over time.ResultsEndotoxemia caused cardiovascular changes typical for hyperdynamic sepsis and, although renal hyperemia occurred, impaired renal function in both groups. Compared with conscious animals, isoflurane significantly (P < 0.05) reduced urine output, renal creatinine clearance, fractional sodium excretion and renal blood flow during endotoxemia. Furthermore, the plasma concentrations of urea and creatinine increased more in the anesthetized animals. Isoflurane anesthesia also enhanced neutrophil activity and accumulation in the kidney during endotoxemia. N-acetyl-beta-d-glucosaminidase was significantly increased, with no inter-group difference as an indication of tubular injury.ConclusionsThe results of the current study suggest that isoflurane anesthesia (minimum alveolar concentration 1.0) with mechanical ventilation aggravates renal dysfunction during 48 h of endotoxemia and does not significantly reduce the inflammatory response or signs of tubular damage.