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Epidural anesthesia may attenuate lipid peroxidation during aorto-femoral surgery

[L’anesthésie péridurale peut diminuer la peroxydation lipidique pendant une intervention chirurgicale aorto-fémorale]

Lale Yüceyar, MD^*, Hülya Erolçay, MD^*, Dildar Konukoglu, MD, A. Kürsat Bozkurt, MD FEBCS and Bora Aykaç, MD^*

^* From the Departments of Anesthesiology,
Biochemistry, and
Cardiovascular Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Address correspondence to: Dr. Lale Yüceyar, Turunclu sok. Ugur apt. 23/A D:25, Merter 34010, Istanbul, Turkey. Phone: 00 90 212 502 35 35; Fax: 00 90 212 633 48 41; E-mail: Lyuceyar{at}hotmail.com

Purpose: To determine the effect of epidural anesthesia (EP) on oxygenation of the chronically ischemic limb in patients undergoing aorto-femoral bypass grafting and to assess whether it produces an alteration of lipid peroxidation and antioxidant status following revascularization.

Methods: In this prospective, randomized, single-blinded study 40 ASA II or III patients undergoing elective aorto-femoral bypass grafting were allocated to receive general anesthesia (group GA, n = 20), or epidural + GA (group EP, n = 20) during surgery. Femoral venous blood-gas status, activities of the protecting antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-px), glutathione reductase (GSH-rd), glutathione (GSH) and thiobarbituric acid-reactive substances (TBARS) as a marker of lipid peroxidation were determined in blood samples taken from the femoral vein at different intervals before and after revascularization.

Results: Before the induction of anesthesia in group EP, femoral venous PO₂ [mean (standard deviation), 95% confidence interval] increased after achieving an adequate level of blockade by EP extending to the dermatomal level of T6–8 [29.32 (4.6), 26.34–32.30 to 36.29 (4.6), 33.37–39.22 mmHg, P < 0.05]. Femoral venous PO₂ was similar in both groups thereafter. In the GA group a significant increase in erythrocyte TBARS was observed immediately after restoration of blood flow when compared with baseline values [221.32 (102), 148.35–294–29 to 337.26 (123) 248.99–425.53 nmol•g^–1 hemoglobin, P < 0.01] but not at any other moment. In the EP group TBARS did not increase throughout the study. Within group comparisons revealed no significant differences in GSH, GSH-px, GSH-rd and SOD.

Conclusion: In patients with atherosclerotic aorto-iliac occlusive disease EP may possibly attenuate lipid peroxidation following revascularization but has no effect on antioxidant enzyme activities.