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Anesth Analg 2005;100:1786-1792
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000152007.14854.6B

CRITICAL CARE AND TRAUMA

Preconditioning with Monophosphoryl Lipid A Improves Survival of Critically Ischemic Tissue

Yves Harder, MD, Claudio Contaldo, MD, Joachim Klenk, MD, Andrej Banic, MD, PhD, Stephan M. Jakob, MD, PhD, and Dominique Erni, MD

From the Department of Plastic Surgery and the Surgical Research Unit, Inselspital University Hospital, Berne, Switzerland

Address correspondence and reprint requests to Yves Harder, MD, Department of Plastic Surgery Inselspital University Hospital CH-3010 Berne, Switzerland. Address e-mail to yvesharder{at}bluewin.ch.

In this study we sought to assess the effects of preconditioning with monophosphoryl lipid A on critically ischemic wound margins and on systemic and local hemodynamics and oxygenation during prolonged anesthesia with volatile anesthetics and narcotics. Twenty large white pigs were randomly assigned to receive either monophosphoryl lipid A 35 µg/kg IV or saline 24 h before dissection of a buttock flap. The animals were anesthetized with isoflurane (end-tidal concentration approximately 1.25%) for surgery and subsequent monitoring of hemodynamics and oxygenation both systemically and in the flap tissue for 6 h. Preconditioning resulted in increased cardiac index and oxygen delivery (both P < 0.05) and in decreased central venous pressure and systemic vascular resistance (both P < 0.01). In the preconditioned flap tissue, microcirculatory blood flow (laser Doppler flowmetry) and partial tissue oxygen tension (polarographic microprobes) were up to 2.5-fold higher compared with control (both P < 0.05) and flap necrosis was reduced by 20% on postoperative day 14 (P < 0.05). Our results suggest that preconditioning with a single dose of monophosphoryl lipid A may attenuate ischemia-related wound healing complications, which may be related to an improvement in perfusion and oxygenation of this tissue. Furthermore, preconditioning exerted a systemic cardiovascular stabilization effect during prolonged isoflurane anesthesia.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2005 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.