Isoflurane Increases Tolerance to Renal Ischemia Reperfusion Injury Compared to Propofol: An Experimental Study in Pigs

Abstract

Purpose: To compare two clinically relevant anesthetic agents, i.e., isoflurane versus propofol with respect to protection of the kidney in a porcine renal ischemia reperfusion model. Materials and Methods: 14 hybrid pigs were randomized to anesthesia with either isoflurane or propofol prior to laparoscopic surgery. Following anesthesia, the left kidney hilum was clamped for 60 min and the right kidney removed. After 48 h of reperfusion, urine was sampled for analysis of neutrophil gelatinase-associated lipocalin (NGAL), albumin, and creatinine. The left kidney was harvested for histologic scoring of injury. Results: Histologic examination of renal injury revealed a statistically significant difference in favor of isoflurane on denuded basement membrane score (isoflurane group 1.58 ± 0.38 vs. propofol 2.42 ± 0.80, p = .026). Median (25–75 percentile) urinary albumin 3.4 g/L (2.25–7.48) vs. 8.9 g/L (3.73–13.8), (p = .041) and urinary albumin/creatinine ratio 1.17 (0.76–1.82) vs. 1.76 (1.63–5.99), (p = .026) were both significantly lower in the isoflurane group. Median (25–75 percentile) urinary NGAL was 167 (51–215) pg/ml in the isoflurane group compared with 362 (149–508) pg/ml in the propofol group (p = .093). Conclusion: Isoflurane increases tolerance to renal ischemia reperfusion injury compared to propofol in this model.

Keywords

• ischemia-reperfusion
• isoflurane
• kidney
• laparoscopy
• propofol