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Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial
BACKGROUND: Hepatectomy with inflow occlusion results in ischemia-reperfusion injury; however, pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients. The normal inflammatory response after a hepatectomy involves increased expressio...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701968/ https://www.ncbi.nlm.nih.gov/pubmed/33312433 http://dx.doi.org/10.4254/wjh.v12.i11.1098 |
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author | Koraki, Eleni Mantzoros, Ioannis Chatzakis, Christos Gkiouliava, Anna Cheva, Angeliki Lavrentieva, Athina Sifaki, Freideriki Argiriadou, Helena Kesisoglou, Isaak Galanos-Demiris, Konstantinos Bitsianis, Stefanos Tsalis, Konstantinos |
author_facet | Koraki, Eleni Mantzoros, Ioannis Chatzakis, Christos Gkiouliava, Anna Cheva, Angeliki Lavrentieva, Athina Sifaki, Freideriki Argiriadou, Helena Kesisoglou, Isaak Galanos-Demiris, Konstantinos Bitsianis, Stefanos Tsalis, Konstantinos |
author_sort | Koraki, Eleni |
collection | PubMed |
description | BACKGROUND: Hepatectomy with inflow occlusion results in ischemia-reperfusion injury; however, pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients. The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases, which may signal pathologic hepatic tissue reformation. AIM: To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy. METHODS: This is a single-center, prospective, randomized controlled trial conducted at the 4(th) Department of Surgery of the Medical School of Aristotle University of Thessaloniki, between August 2016 and December 2017. Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning (by replacement of propofol with desflurane, administered 30 min before induction of ischemia) or the control group for standard intravenous propofol. The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion. The secondary endpoints of neutrophil infiltration, coagulation profile, activity of antithrombin III (AT III), protein C (PC), protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups. RESULTS: The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2, significantly decreased levels of matrix metalloproteinases 2 and 9, decreased neutrophil infiltration, and less profound changes in the coagulation profile. During the 5-d postoperative period, all patients showed significantly decreased activity of AT III, PC and protein S (vs baseline values, P < 0.05). The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5 (P < 0.05), showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group. Compared to the control group, the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days (P < 0.005) and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3 (P < 0.05). Total length of stay was significantly less in the desflurane group (P = 0.009). CONCLUSION: Desflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization. |
format | Online Article Text |
id | pubmed-7701968 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-77019682020-12-10 Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial Koraki, Eleni Mantzoros, Ioannis Chatzakis, Christos Gkiouliava, Anna Cheva, Angeliki Lavrentieva, Athina Sifaki, Freideriki Argiriadou, Helena Kesisoglou, Isaak Galanos-Demiris, Konstantinos Bitsianis, Stefanos Tsalis, Konstantinos World J Hepatol Randomized Controlled Trial BACKGROUND: Hepatectomy with inflow occlusion results in ischemia-reperfusion injury; however, pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients. The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases, which may signal pathologic hepatic tissue reformation. AIM: To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy. METHODS: This is a single-center, prospective, randomized controlled trial conducted at the 4(th) Department of Surgery of the Medical School of Aristotle University of Thessaloniki, between August 2016 and December 2017. Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning (by replacement of propofol with desflurane, administered 30 min before induction of ischemia) or the control group for standard intravenous propofol. The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion. The secondary endpoints of neutrophil infiltration, coagulation profile, activity of antithrombin III (AT III), protein C (PC), protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups. RESULTS: The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2, significantly decreased levels of matrix metalloproteinases 2 and 9, decreased neutrophil infiltration, and less profound changes in the coagulation profile. During the 5-d postoperative period, all patients showed significantly decreased activity of AT III, PC and protein S (vs baseline values, P < 0.05). The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5 (P < 0.05), showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group. Compared to the control group, the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days (P < 0.005) and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3 (P < 0.05). Total length of stay was significantly less in the desflurane group (P = 0.009). CONCLUSION: Desflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization. Baishideng Publishing Group Inc 2020-11-27 2020-11-27 /pmc/articles/PMC7701968/ /pubmed/33312433 http://dx.doi.org/10.4254/wjh.v12.i11.1098 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Randomized Controlled Trial Koraki, Eleni Mantzoros, Ioannis Chatzakis, Christos Gkiouliava, Anna Cheva, Angeliki Lavrentieva, Athina Sifaki, Freideriki Argiriadou, Helena Kesisoglou, Isaak Galanos-Demiris, Konstantinos Bitsianis, Stefanos Tsalis, Konstantinos Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial |
title | Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial |
title_full | Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial |
title_fullStr | Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial |
title_full_unstemmed | Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial |
title_short | Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial |
title_sort | metalloproteinase expression after desflurane preconditioning in hepatectomies: a randomized clinical trial |
topic | Randomized Controlled Trial |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701968/ https://www.ncbi.nlm.nih.gov/pubmed/33312433 http://dx.doi.org/10.4254/wjh.v12.i11.1098 |
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