Laboratory Investigations
Sevoflurane preconditions stunned myocardium in septic but not healthy isolated rat hearts

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Background

Recent evidence indicates that sevoflurane treatment before prolonged ischaemia reduces infarct size in normal hearts, mimicking ischaemic preconditioning. We examined whether exposure to sevoflurane before brief ischaemia, inducing a ‘stunned myocardium’, provided such protective effects in an isolated working heart from normal or septic rats.

Methods

With institutional approval, 91 rats were randomly allocated into one of either caecal-ligation and perforation (CLP: n=50) or sham (Sham: n=41) procedure groups 24 h before the study. After determination of baseline measurements, including cardiac output (CO), myocardial oxygen consumption (m V˙o2) and cardiac efficiency (CE; CO×peak systolic pressure/m V˙o2), each isolated heart was perfused with or without 2% sevoflurane for 15 min before global ischaemia (pre-ischaemia). After 15 min ischaemia and 30 min reperfusion, all hearts were assessed for functional recovery of myocardium (post-reperfusion).

Results

During the pre-ischaemia period, 2% sevoflurane caused a significant reduction of CO in the CLP group compared with the Sham group. During the post-reperfusion period, both CO (16.9 vs 11.0 ml min−1) and CE (11.2 vs 7.7 mm Hg ml−1 (μl O2)−1) was higher in the sevoflurane-treated vs -untreated hearts from CLP rats, and was accompanied by lower incidence of reperfusion arrhythmia compared with control hearts (8 vs 32%). In contrast, 2% sevoflurane did not provide cardioprotective effects in normal rats.

Conclusions

The current study demonstrates that pre-treatment with sevoflurane minimizes myocardial dysfunction and the incidence of reperfusion arrhythmia after brief ischaemic insults in septic hearts.

Key words

anaesthetics volatile, sevoflurane
heart, reperfusion arrhythmia
infection, sepsis

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Accepted for publication: July 23, 2002