Inserm, Institut national de la santé et de la recherche médicale
Faculté de pharmacie, Aix Marseille Université

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Sevoflurane preconditioning against focal cerebral ischemia : Sustain inhibition of apoptosis in the face of transient improvement of neurological outcome

Jean-Laurent Codaccioni, Lionel J. Velly. Chahrazad Moubarik,, Nicolas J. Bruder,, Benjamin A. Guillet and Pascale S. Pisano. 2009. Anesthesiology Pages 110(6):1271-8. Impact factor IF 5,359

Abstract

BACKGROUND :
Preconditioning the brain with volatile anesthetics seems to be a viable option for reducing ischemic cerebral injury. However, it is uncertain whether this preconditioning effect extends over a longer period of time. The purpose of this study was to determine if sevoflurane preconditioning offers durable neuroprotection against cerebral ischemia.

METHODS :
Rats (Sprague-Dawley) were randomly allocated to two groups : nonpreconditioned control group (n = 44) and preconditioned group (n = 45) exposed to 2.7 vol% sevoflurane (45 min) 60 min before surgery. Animals in both groups were anesthetized with 3.0 vol% sevoflurane and subjected to transient middle cerebral artery occlusion. After 60 min of awake focal ischemia, the filament was removed. Functional neurologic outcome (range 0-18 ; 0 = no deficit), cerebral infarct size (Nissl staining), and apoptosis (Terminal deoxynucleotidyl transferase-mediated 2’-deoxyuridine 5’-triphosphate nick-end labeling ; cleaved caspase-3 staining) were evaluated at 3, 7, and 14 days after ischemia.

RESULTS :
Sevoflurane preconditioning significantly improved functional outcome and reduced infarct volume (109 +/- 43 vs. 148 +/- 56 mm(3)) 3 days after ischemia compared to the control group. However, after 7- and 14-day recovery periods, no significant differences were observed between groups. The number of apoptotic cells was significantly lower in the preconditioned group than in the control group after 3- and 7-day recovery periods. Fourteen days after ischemia, no differences were observed between groups.

CONCLUSION :
In this model of transient focal cerebral ischemia, sevoflurane preconditioning induced effective but transient neuroprotective effects. Sevoflurane preconditioning also decreased ischemia-induced apoptosis in a more sustained way because it was observed up to 7 days after injury.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Sevoflurane+preconditioning+against+focal+cerebral+ischemia%3A+Sustain+inhibition+of+apoptosis+in+the+face+of+transient+improvement+of+neurological+outcome.