Cytotoxic effects of volatile anesthetics with free radicals undergoing laparoscopic surgery Remziye Sivaci a, ⁎ , Ahmet Kahraman b , Mustafa Serteser b , Dursun Ali Sahin c , Osman Nuri Dilek c a Department of Anesthesiology, Afyon Kocatepe University, Dumlupınar Mh. Turabi Cd. Tutuncu Apt. B Blok 5/9, Afyon 03200, Turkey b Department of Biochemistry, Kocatepe University School of Medicine, Afyon, Turkey c Department of General Surgery, Kocatepe University School of Medicine, Afyon, Turkey Received 5 June 2005; received in revised form 1 December 2005; accepted 2 January 2006 Available online 21 February 2006 Abstract Background: Free radicals induced by several diseases can trigger oxidative stress, leading to the production of malondialdehyde (MDA) and protein carbonyl content (CB). Volatile agents are able to increase the extent of oxidative status. However, the effects of these agents together with pneumoperitonium (Pp) have not been reported. We aimed to investigate the role of volatile anesthetics and ischemic injury during Pp on free radicals and scavenging enzymes in laparoscopic abdominal surgery. Methods and materials: Forty patients were examined. Patients were randomly divided into four groups in order to receive sevoflurane- fentanyl (SF = 10), sevoflurane-N 2 O (SN = 10), desflurane-fentanyl (DF = 10), and desflurane–N 2 O (DN = 10), respectively. Tidal volume and ventilation frequency were kept unchanged during the operation. Intraabdominal pressure was remained constant at 12 mm Hg. Baseline values in venous blood samples were preoperatively taken and blood was also taken postoperatively at the 6th and the 24th hours. After collection of blood samples into citrate (3.5 mg/mL blood) containing glass tubes, erythrocyte sediments were prepared for the analyses. Then malondialdehyde levels, protein carbonyl content, and sulfhydryl (SH) groups were measured. Results: The levels of MDA and protein carbonyl content were significantly higher at the 6th hour rather than the 24th hour postoperatively with desflurane anesthesia. In addition, SH groups were significantly different between the 6th hour and the 24th hour measurements (P b 0.05). In our study, desflurane caused a statistically significant increase in MDA levels and protein carbonyl content and a decrease in SH groups. When the two groups were compared, in the case of MDA and CB values, a significant increase was observed in the 6th and the 24th hour, where there was a decrease in SH groups in the desflurane group (P b 0.05). These parameters did not change in the sevoflurane group (P N 0.05). Conclusion: We concluded that desflurane was affected by desflurane with low flow anesthesia in patients undergoing laparoscopic abdominal surgery. Significant influence on oxidative stress and antioxidant mechanics was not seen with sevoflurane anesthesia. Our studies support that oxidant and antioxidant defense mechanisms were altered in the desflurane group and this alteration improved after a combination of desflurane-N 2 O. © 2006 The Canadian Society of Clinical Chemists. All rights reserved. Keywords: Oxidative stress; Reactive oxygen species; Volatile anesthetics; Antioxidant enzymes Introduction Oxidative stress has been incriminated as one of several mechanisms that have induced toxic effects in different organs due to enhanced production of oxygen free radicals. Overpro- duction of oxygen free radicals while the natural scavenging mechanisms are weakened is a process that is implicated in endothelial cell damage and multiorgan failure [1]. Oxygen free radicals, which include malondialdehyde (MDA), hydrogen peroxide, and hydroxyl radicals, cause “oxidative stress.” Diminished antioxidative defenses, e.g., superoxide dismutase, catalase, and glutathione (GSH), also contribute to oxidative stress. Free radicals may lead to the peroxidation of lipids, nucleic acids, proteins, apoptosis, immunity, and defense against microorganisms. One of the end-points of ROS- mediated protein damage is the formation of protein carbonyl groups, caused by the oxidation of specific amino acid residues [2–5]. Malondialdehyde (MDA) is a low molecular weight aldehyde that results from free radical attacks on polyunsaturated fatty Clinical Biochemistry 39 (2006) 293 – 298 ⁎ Corresponding author. Fax: +90 272 215 82 81. E-mail addresses: rsivaci@aku.edu.tr, anilyarkin@yahoo.com.au (R. Sivaci). 0009-9120/$ - see front matter © 2006 The Canadian Society of Clinical Chemists. All rights reserved. doi:10.1016/j.clinbiochem.2006.01.001