Investigation of the Effects of Sevoflurane and Desflurane on Erythrocyte Deformability in Transient Hyperglycemia
Abstract
Aim: Micro and macrovascular complications due to long-term hyperglycemia are associated with increased mortality and morbidity. Erythrocytes exposed to hyperglycemia for a long time may cause morphological changes in erythrocytes such as decreased deformability and development of aggregation. As a result, complications such as shortening life span of erythrocytes, impairment of oxygen carrying capacity, tissue hypoxia may occur. In our study, we would like to investigate the effects of Sevoflurane and Desflurane on erythrocyte deformability during transient hyperglycemia. Materials and Methods: In this study, 30 male Wistar albino rats were used. The animals were randomly divided into five groups, each contained 6 rats: Diabetic control (group DC), diabetic hyperglycemia group (group DH), diabetic hyperglycemia group with desflurane (group DH-D), and diabetic hyperglycemia group with sevoflurane (group DH-S) groups. Another 6 rats without diabetes were assigned as control group (group C). Streptozotocin-induced diabetic rats were kept 6 weeks, then transient hyperglycemia was created, and the administration of sevoflurane and desflurane were performed. After 24 hours blood samples were obtained and deformability measurements were performed in erythrocyte suspensions containing Htc 5% in a PBS buffer. Results: Diabetes mellitus was found to increase relative resistance in the control group (p <0.0001). Acute hyperglycemia increased relative resistance in diabetes control, relatively. Group DH, Group DH-D and Group DH-S deformability index were significantly different when compared to Group DC (p=0.007, p=0.025, p=0.016, respectively). It was found that administration of desflurane or sevoflurane did not alter erythrocyte deformability during acute hyperglycemia (p = 0.591, p = 0.739). Conclusion: As a consequence, we think that we can safely use inhalation anesthetics such as Desflurane and Sevoflurane during acute hyperglycemia attacks. But, it needs further investigation as both experimental and clinicalReferences
Diabetes Atlas 2003. International Diabetes Federation, Brussels, 2003.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53.
Watala C, Zawodniak M, Bryszewska M, Nowak S. Nonenzymatic protein glycosylation. I. Lowered erythrocyte membrane fluidity in juvenile diabetes. Ann Clin Res 1985;17:327–30.
Cohen RM, Franco RS, Khera PK, Smith EP, Lindsell CJ, Ciraolo PJ, et al. Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c. Blood 2008;112:4284-91.
Fujita J, Tsuda K, Takeda T, Yu L, Fujimoto S, Kajikawa M, et al. Nisoldipine improves the impaired erythrocyte deformability correlating with elevated intracellular free calcium-ion concentration and poor glycaemic control in NIDDM. Br J Clin Pharmacol 1999;47:499-506.
Bareford D, Jennings PE, Stone PC, Baar S, Barnett AH, Stuart J. Effects of hyperglycaemia and sorbitol accumulation on erythrocyte deformability in diabetes mellitus. J Clin Pathol 1986;39:722-7.
Symeonidis A, Athanassiou G, Psiroyannis A, Kyriazopoulou V, Kapatais-Zoumbos K, Missirlis Y, et al. Impairment of erythrocyte viscoelasticity is correlated with levels of glycosylated haemoglobin in diabetic patients. Clin Lab Haematol 2001;23:103-9.
Erdogan C, Erdem A, Akıncı SB, Dikmenoglu N, Basgül E, Balkancı D, et al. The effects of midazolam on erythrocyte deformability and plasma viscosity in rats. Anestezi Dergisi. 2005;13:205–8.
Muller R, Musikic P. Hemorheology in surgery: A review. Angiology. 1987;38:581-92.
Dormandy JA. Effects of anaesthesia and surgery on the flow properties of blood. Microcirc Endothelium Lymphatics 1984;1:151-68.
Robertshaw HJ, Hall GM. Diabetes mellitus: anaesthetic management. Anaesthesia 2006; 61:1187–90.
McAnulty GR, Robertshaw HJ, Hall GM. Anaesthetic management of patients with diabetes mellitus. Br J Anesth 2000; 85: 80–90.
McAnulty GR, Hall GM. Anaesthesia for the diabetic patient. Br J Anesth 2003; 88: 428–30
Loomans CJ, de Koning EJ, Staal FJ, Rookmaaker MB, Verseyden C, de Boer HC, et al. Endothelial progenitor cell dysfunction; a novel concept in the pathogenesis of vascular complications of type 1 diabetes. Diabetes 2004;53:195-9.
Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology and management. JAMA 2002;287:2570-25.
Yeom E, Byeon H, Lee SJ. Effect of diabetic duration on hemorheological properties and platelet aggregation in streptozotocin-induced diabetic rats. Sci Rep 2016; 22;6:21913. doi: 10.1038/srep21913.
Zinchuk VV. Erythrocyte deformability: physiological aspects. Usp Fiziol Nauk 2001;32:66-78.
de Oliveira S, Silva-Herdade AS, Saldanha C. Modulation of erythrocyte deformability by PKC activity. Clin Hemorheol Microcirc 2008;39:363-73.
George A, Pushkaran S, Li L, An X, Zheng Y, Mohandas N, et al. Altered phosphorylation of cytoskeleton proteins in sickle red blood cells: the role of protein kinase C, Rac GTPases, and reactive oxygen species. Blood Cells Mol Dis 2010; 45:41-5.
Manno S, Takakuwa Y, Mohandas N. Modulation of erythrocyte membrane mechanical function by protein 4.1 phosphorylation. J Biol Chem 2005;280:7581-7.
Palfrey HC, Waseem A. Protein kinase C in the human erythrocyte. Translocation to the plasma membrane and phosphorylation of bands 4.1 and 4.9 and other membrane proteins. J Biol Chem 1985; 260:16021-9.
Fornal M, Korbut RA, Krolczyk J, Grodzicki T. Evolution of rheological properties of erythrocytes and left ventricular geometry in cardiovascular disease risk patients. Clin Hemorheol Microcirc 2010;45:155-9.
Tomaiuolo G. Biomechanical properties of red blood cells in health and disease towards microfluidics. Biomicrofluidics 2014; 8:051501. doi: 10.1063/1.
Toth A, Papp J, Rabai M, Kenyeres P, Marton Z, Kesmarky G, et al. The role of hemorheological factors in cardiovascular medicine. Clin Hemorheol Microcirc 2014;56:197-204.
Popel AS, Johnson PC. Microcirculation and hemorheology. Annu Rev Fluid Mech 2005;37:43-69.
Le Devehat C, Khodabandehlou T, Vimeux M. Relationship between hemorheological and microcirculatory abnormalities in diabetes mellitus. Diabete Metab 1994;20(4):401–4.
Zimny S, Dessel F, Ehren M, Pfohl M, Schatz H. Early detection of microcirculatory impairment in diabetic patients with foot at risk. Diabetes Care 2001;24:1810–4.
Pirart J. Diabetes and its degenerative complications. A prospective study of 4440 patients observed between 1974 and 1973. Diabete Metab. 1977;3:97-107.
David JS, Tavernier B, Amour J, Vivien B, Coriat P, Riou B. Myocardial effects of halothane and sevoflurane in diabetic rats. Anesthesiology 2004;100:1179-87.
Dormandy JA. Effect of anesthesia and surgery on the flow rheology properties of blood. Microcirc Endothelium Lymphatics 1984;1:151-168
Aydoğan S, Yerer MB, Comu FM, Arslan M, Güneş-Ekinci I, Unal Y, et al. The influence of sevoflurane anesthesia on the rat red blood cell deformability. Clin Hemorheol Microcirc 2006;35:297-300.
Yerer MB, Aydoğan S, Comu FM, Arslan M, Güneş-Ekinci I, Kurtipek O, et al. The red blood cell deformability alterations under desfluran anesthesia in rats. Clin Hemorheol Microcirc 2006;35:213-6.
Yerer MB, Aydoğan S, Comu FM. Gender-related alerations in erythrocyte mechanical activities under desflurane or sevoflurane anesthesia. Clin Hemorheol Microcirc 2008;39:423-7.
Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycemia and increased risk after myocardial infarction in patients without diabetes: a systematic overview. Lancet 2000;355:773–8.
Davies MJ, Lawrence IG. DIGAMI (diabetes mellitus, insulin glucose infusion in acute myocardial infarction): theory and practice. Diabetes Obes Metab 2001;4:289–95.
Van Den Berghe G, Wouters P, Weekers F et al. Intensive insülin therapy in critically ill patients. N Engl J Med 20001;345:1359–67.
Scott JF, Robinson GM, French JM, O'Connell JE, Alberti KG, Gray CS. Blood pressure response to glucose potassium insulin therapy in patients with acute stroke with mild to moderate hyperglycemia. J Neurol Neurosurg Psychiat 2001;70:401–4.
Bruno A, Williams LS, Kent TA. How important is hyperglycemia during acute brain infarction? Neurologist 2004;10:195–200.
Livshits L, Srulevich A, Raz I, Cahn A, Barshtein G, Yedgar S et al. Effect of short-term hyperglycemia on protein kinase C alpha activation in human erythrocytes. Rev Diabet Stud 2012; 9:94-103.
Riquelme B, Foresto P, D'Arrigo M, Valverde J, Rasia R. A dynamic and stationary rheological study of erythrocytes incubated in a glucose medium. J Biochem Biophys Methods 2005;62:131-41.
Shin S, Ku YH, Suh JS, Singh M. Rheological characteristics of erythrocytes incubated in glucose media. Clin Hemorheol Microcirc 2008;38:153-61.
Diltoer M, Camu F. Glucose homeostasis and insulin secretion during isoflurane anesthesia. Anesthesiology 1988;68:880-6.
David JS, Tavernier B, Amour J, Vivien B, Coriat P, Riou B. Myocardial effects of halothane and sevoflurane in diabetic rats. Anesthesiology 2004;100:1179-87.
Kadoi Y. Blood glucose control in the perioperative period. Minerva Anestesiol 2012;78:574-95.
Efrati S, Berman S, Hamad RA, Siman-Tov Y, Chanimov M, Weissgarten J. Hyperglycaemia emerging during general anaesthe-sia induces rat acute kidney injury via impaired microcirculation, augmented apoptosis and inhibited cell proliferation. Nephrology 2012;17:111–22.
Dikmen B, Arpaci AH, Kalayci D, Gunes I, Beskardes E, Kurtipek O, et al. Are there any effects of Sevoflurane and Desflurane anaes-thesia on blood glucose levels in acute hyperglycemic diabetic rats? Bratisl Med J 2016;117:351–4.
