ESTELA REGINA RAMOS FIGUEIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject EFFECTS OF ANAESTHETIC PRECONDITIONING PLUS POSTCONDITIONING WITH SEVOFLURANE IN WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) FILHO, J. A. R.; FIGUEIRA, E. R. R.; SCHIMMER, B. B.; ANDRE, V. O.; BUTO, M. F. de Souza; NAKATANI, M.; PRADO, F. J. G.; CARMONA, M. J. C.; CLAVIEN, P. A.; D'ALBUQUERQUE, L. A. C.Background: Preconditioning is a therapeutic strategy aimed to increase ischemic tissue tolerance against ischemia/reperfusion (IR) injury. Recent studies demonstrated that volatile anaesthetics may improve postischemic recovery by an ischemic preconditioning-like mechanism. Postconditioning is a new concept that may have hepatoprotective effect. We hypothesized that sevoflurane preconditioning combined with postconditioning may reduce the hepatocellular damage in a rat model of warm liver IR. Methods: Ten Wistar rats under mechanical ventilation were divided into 2 groups of 5; 1) IR: rats subjected to 45 min of warm liver ischemia of left and median lobes, followed by resection of non-ischemic lobes at early reperfusion; and 2) SEVO + IR: rats were exposed to sevoflurane 2.5% for 15 min, followed by 5 min washout, before ischemia, plus sevoflurane 2.5% for 15 minat reperfusion. Carotid artery was cannulated for mean arterial pressure(MAP). Mean portal flow (MPF) was assessed by perivascular flowprobe. MAP and MPF were recorded at baseline, pre-repefusion and 4 h postreperfusion. Liver transaminases, creatinine, pH, bicarbonate (BIC) and base excess (BE), potassium (K), glucose and lactate were measured at 4 h postreperfusion. Results: AST and ALT were decreased in SEVO + IR group (12.118 ± 3.611 and 7.870 ± 1.586 U/L) compared to IR group (16.890 ± 1.630 and13.418 ± 1.088 U/L), P < 0.05. BIC, and K were increased in SEVO + IR group (11.20 ± .86 mmol/l and 6.1 ± 1.3 mEq/dl) compared to IR (6.70 ± 3.32 mmol/l and 4.7 ± 0.7 mEq/dl),P < 0.05. There were no differ- ences in MAP, MPF, creatinine, glucose, lactate, pH and BE; however glucose tended to be higher in SEVO + IR group (50.8 ± 26.0 mg/dl) compared to IR (35.0 ± 18.4 mg/dl). Conclusions: In experimental warm liver ischemia/reperfusion, sevoflurane preconditioning plus postconditioning reduced the hepatocellular injury demonstrated by lower levels of transaminases with a better behaviour of acid base variables and good hemodynamic recovery. These preliminary results are encouraging because postconditioning may have the advantage of being implemented at the moment of reperfusion, what is more feasible to be applied during liver transplantation surgery.conferenceObject Anesthetic Conditioning in Liver Transplantation: A multicenter randomized controlled trial(2013) KAJDI, Marie-Elisabeth; BONVINI, John M.; SCHADDE, Erik; FIGUEIRA, Estela R. R.; FILHO, Joel A. Rocha; REYNTJENS, Koen; PUHAN, Milo A.; CLAVIEN, Pierre-Alain; BREITENSTEIN, Stefan; BECK-SCHIMMER, BeatriceconferenceObject EFFECTS OF ANAESTHETIC PRECONDITIONING WITH SEVOFLURANE IN WARM LIVER ISCHEMIA/REPERFUSION INJURY IN RATS(2012) FIGUEIRA, E. R. R.; FILHO, J. A. R.; SCHIMMER, B. B.; NAKATANI, M.; TATEBE, E. R.; ANDRE, V. O.; PRADO, F. J. G.; CARMONA, M. J. C.; D'ALBUQUERQUE, L. A. C.Background: Preconditioning is a therapeutic strategy aimed to increase ischemic tissue tolerance against ischemia/reperfusion (IR) injury. Recentstudies demonstrated that volatile anaesthetics may improve postischemic recovery by an ischemic preconditioning-like mechanism. We hypothesized that pharmacological preconditioning with sevoflurane may reduce the hepatocellular damage in a rat model of warm liver IR. Methods: Ten Wistar rats under mechanical ventilation were divided into 2 groups of 5 animals: I) IR: rats subjected to 45 min of warm liver ischemia of the left and median lobes, followed by resection of the non-ischemic lobes at early reperfusion; and II) SEVO+IR: rats were exposed to sevoflurane 2.5% for 15 min, followed by washout during 5 min, before IR. The carotid artery was cannulated for mean arterial pressure (MAP) monitoring. The mean portal venous flow (MPF) was assessed by perivascular flowprobe. MAP and MPF were recorded at baseline, pre reperfusion and 4 hours post-reperfusion. Liver transaminases, creatinine, pH, bicarbonate (BIC) and base excess (BE), potassium (K), glucose and lactate were measured at 4 hours post-reperfusion. Results: AST and ALT were decreased in SEVO+IR group (10.056 ± 5.830 and 8.586 ± 5.296 U/L) compared to IR group (16.890 ± 1.630 and 13.418 ± 1.088 U/L), P < 0.05. BIC, BE and K were increased in SEVO+IR group (12.42 ± 4.39, -14.72 ± 4.46 mmol/l and 6.3 ± 0.9 mEq/dl) compared to IR (6.70 ± 3.32, -20.48 ± 4.22 mmol/l and 4.7 ± 0.7 mEq/dl), P< 0.05. MAP at 4 hours post-reperfusion was decreased in SEVO+IR group (65 ± 24 mmHg) compared to IR (93 ± 14 mmHg), P < 0.05. There were no differences in MPF, creatinine, glucose and lactate. Glucose tended to be higher and lactate lower in SEVO+IR group (54.0 ± 22.7 and 42.8 ± 18.6 mg/dl) compared to IR (35.0 ± 18.4 and 66.8 ± 25.9 mg/dl). Conclusions: In liver IR, sevoflurane preconditioning reduced hepatocellular injury demonstrated by lower levels of transaminases. Despite the lower mean arterial pressure presented in sevoflurane treated animals, no detrimental effect was observed in portal venous flow, hepatic metabolism and renal function. This study highlight the need for clarifying the mechanisms of sevoflurane preconditioning, and if there is additional hepatoprotection against cold IR injury.- Conditioning With Sevoflurane in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2015) BECK-SCHIMMER, Beatrice; BONVINI, John M.; SCHADDE, Erik; DUTKOWSKI, Philipp; OBERKOFLER, Christian E.; LESURTEL, Mickael; DEOLIVEIRA, Michelle L.; FIGUEIRA, Estela R. R.; ROCHA FILHO, Joel A.; AULER JR., Jose Otavio Costa; D'ALBUQUERQUE, Luiz A. C.; REYNTJENS, Koen; WOUTERS, Patrick; ROGIERS, Xavier; DEBAERDEMAEKER, Luc; GANTER, Michael T.; WEBER, Achim; PUHAN, Milo A.; CLAVIEN, Pierre-Alain; BREITENSTEIN, StefanBackground. During times of organ scarcity and extended use of liver grafts, protective strategies in transplantation are gaining importance. We demonstrated in the past that volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury during liver resection. In this randomized study, we examined if volatile anesthetics have an effect on acute graft injury and clinical outcomes after liver transplantation. Methods. Cadaveric liver transplant recipients were enrolled from January 2009 to September 2012 at 3 University Centers (Zurich/Sao Paulo/Ghent). Recipients were randomly assigned to propofol (control group) or sevoflurane anesthesia. Postoperative peak of aspartate transaminase was defined as primary endpoint, secondary endpoints were early allograft dysfunction, in-hospital complications, intensive care unit, and hospital stay. Results. Ninety-eight recipients were randomized to propofol (n = 48) or sevoflurane (n = 50). Median peak aspartate transaminase after transplantation was 925 (interquartile range, 512-3274) in the propofol and 1097 (interquartile range, 540-2633) in the sevoflurane group. In the propofol arm, 11 patients (23%) experienced early allograft dysfunction, 7 (14%) in the sevoflurane one (odds ratio, 0.64 (0.20 to 2.02, P = 0.45). There were 4 mortalities (8.3%) in the propofol and 2 (4.0%) in the sevoflurane group. Overall and major complication rates were not different. An effect on clinical outcomes was observed favoring the sevoflurane group (less severe complications), but without significance. Conclusions. This first multicenter trial comparing propofol with sevoflurane anesthesia in liver transplantation shows no difference in biochemical markers of acute organ injury and clinical outcomes between the 2 regimens. Sevoflurane has no significant added beneficial effect on ischemia-reperfusion injury compared to propofol.