होम Journal of the American College of Surgeons The effects of propofol and isoflurane on ischemia reperfusion injury in free flaps—a genomic...

The effects of propofol and isoflurane on ischemia reperfusion injury in free flaps—a genomic analysis

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खंड:
203
साल:
2006
भाषा:
english
पृष्ठ:
1
DOI:
10.1016/j.jamcollsurg.2006.05.164
फ़ाइल:
PDF, 49 KB
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आप पुस्तक समीक्षा लिख सकते हैं और अपना अनुभव साझा कर सकते हैं. पढ़ूी हुई पुस्तकों के बारे में आपकी राय जानने में अन्य पाठकों को दिलचस्पी होगी. भले ही आपको किताब पसंद हो या न हो, अगर आप इसके बारे में ईमानदारी से और विस्तार से बताएँगे, तो लोग अपने लिए नई रुचिकर पुस्तकें खोज पाएँगे.
Vol. 203, No. 3S, September 2006

Plastic Surgery II

METHODS: The anti-neoplastic properties of Tamoxifen were investigated on Estrogen receptor negative CAL-62 and BHT101 Anaplastic Thyroid tumour cell lines. The anti-proliferative effects observed using colorimetric dimethyl-thiazol-diphenyltetrazolium
bromide (MTT), pro-apoptotic effects observed using flow cytometry (annexin V). Tumour metastatic potential was investigated with
a Matrigel invasion assay with tamoxifen and chemotactic agent Vascular Endothelial Growth Factor. A Fluro-4 Calcium label dye was
employed to investigate induction of apoptosis via calcium intracellular flux.
RESULTS:
Tamoxifen
Proliferation
Apoptosis
Migration
Invasion
Assay

Control
100
4.7 ⫾ 0.46
Control
95.8 ⫾ 3.1

1 ug/ml
97 ⫾ 1.07*
11.2 ⫾ 2.39
Tamoxifen
0*

2 ug/ml
93 ⫾ 0.75
26.4 ⫾ 14*
Vegf
124⫾3.15**

5 ug/ml
64 ⫾ 1.07**
24.8 ⫾ 2.19
Tamx ⫹vegf

10 ug/ml

S63

METHODS: Female swine were sedated with a telazol, xylazine and
ketamine cocktail. A vertical rectus abdominus flap was outlined and
control muscle and fat biopsies taken. Animals were anesthetized
with either isoflurane (n⫽2) or propofol (n⫽2) before undergoing a
3 hour period of ischemia. Following 3 hours of reperfusion, muscle
and fat biopsies were taken. RNA was extracted and gene expression
characterized using the Affymetrix GeneChip Porcine Array (n⫽16).
Overall gene expression of the combined muscle and fat change
relative to baseline was calculated using a rank products test. Relative
expression was reported as a ratio of isoflurane to propofol anesthesia,
with ⬎⫽2 or ⬍⫽0.5 being considered significant changes for isoflurane and propofol respectively.

23 ⫾ 1.07**
22.9 ⫾ 6.89

45.6⫾3.14**

P ⬍0.05 vs. control Anova Scheffe post hoc analysis

RESULTS: Relative gene expression changes and isoflurane/
propofol expression ratios are shown in the table.
Table
Category

Propofol

I/P Ratio

Inflammation

Interleukin 6 (IL-6)

6.3

121.4

.05

6.8

39.2

.17

4.5

25.1

.18

6.9

36.9

.19

109.3

29.6

Thrombosis; 

Monocyte chemoattractant
protein (MCP-1)
Alveolar macrophagederived chemotactic
factor (AMCF-I)
Chemokine ligand 2
(CXCL2)
Macrophage Inflammatory
Protein (MIP-1 Beta)
Plasminogen activator
inhibitor (PLANHI)
Plasminogen activator
(PLAU)
Tissue factor (TF)
Heme oxygenase (HO)
Heat Shock Protein
(HSP70)
HSP1
HSP5

13.2

74.2

.18

4.9

30.5

.16

3.6
4.0
9.6

9.2
17.2
35.4

.39
.23
.27

23.1
4.0

9.0
1.5

Anaplastic thyroid tumour cells are acutely sensitive to Tamoxifen. It
induces apoptosis via a calcium dependent pathway, decreases proliferation and reduces the metastatic potential through blockade of a
VEGF dependant mechanism.
CONCLUSIONS: Tamoxifen now merits a phase 1 clinical trial as
part of a multimodal chemotherapeutic agent in the treatment of
anaplastic thyroid cancer.

The effects of propofol and isoflurane on ischemia
reperfusion injury in free flaps—a genomic analysis
Kevin J Bruen MD, Danesh K Gupta MD, Robert W Weiss PhD,
Diane M Dunn MS, Susan L Thibeault PhD, Scott McJames BS,
Wenhua Li MS, Marga F Massey MD
University of Utah, Salt Lake City, UT
INTRODUCTION: Ischemia reperfusion is characterized by inflammation, thrombosis and oxidative injury. Anesthetic agents modulate
these states in myocardium and brain. We hypothesize that in free
flaps for oncologic reconstruction, propofol acts as an antioxidant
and isoflurane acts as an anti-inflammatory agent.

Antioxidant
Protective

Gene Title

Isoflurane

3.7

2.6
2.6

CONCLUSIONS: Propofol induces the antioxidant HO, but an inflammatory and pro-coagulation state exists. Isoflurane produces a
relative anti-inflammatory state while both agents induce expression
of HSPs. This data suggests that on a genomic level, isoflurane has a
greater protective effect and may be the preferred agent in free flap
reconstruction.