The effects of anesthesia practices on serum levels of selenium, copper, zinc, iron and antioxidant capacity

In this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol applications in general anesthesia on antioxidant capacity which is measured by malondialdehyde (MDA), glutathion peroxidase (GPx) and serum levels of selenium (Se), copper (Cu), zinc (Zn) and iron (Fe). Intramuscular midazolam premedication of 0.07 mg/kg was administered 30 minutes before the operation to 60 patients over 18 years old who had been in ASA I-III risk group and who would have unilateral lower extremity operation which would be performed with tourniquet under general anesthesia. Intravenous access was applied after monitoring in the operation room. Blood specimen was collected to determine the baseline serum levels of Se, Cu, Zn, Fe, MDA and GPx. Anesthesia was induced with 2-2.5 mg/kg propofol, 1 mg/kg lidocaine and 0.6 mg/kg rocuronium intravenously (iv). In the maintenance of anesthesia of the cases which were separated into three equal groups; under carrier gas of 50:50% O2:N2O 4 L/min, 1 MAC sevoflurane was administered to group S and 1 MAC desflurane to group D; and under carrier gas of 50:50% O2:air 4L/min 6 mg/kg/h propofol and 1 mcg/kg/h fentanyl infusion were administered to group P. Following the intubation, the extremity which would be operated was elevated and covered with Esmarch bandage and tourniquet was applied under 300 mmHg pressure. It was planned to administer 50 mcg fentanyl intravenously even if 20% increase would be observed in baseline values of intraoperative arterial blood pressure or heart rate levels. The demographic data of the patients, operation and tourniquet durations, amount of fentanyl used, amounts of bleeding and blood transfused were recorded. At postoperative 0th, 24th and 48th hours, blood specimens were collected again to determine serum levels of selenium, copper, zinc, iron, MDA and GPx. As a result of statistical analysis, it was observed that in group S and P, levels of MDA, a marker of oxidative stress, were decreased at postoperative 48th hour and levels of GPx, a marker of antioxidant situation, were increased in comparison to baseline levels but no changes were observed in group D. Among the trace elements; decrease in selenium levels at postoperative 0th and 48th hours in group S and at 24th and 48th hours in group P, decrease in zinc levels at 24th hour in group D and at 24th and 48th hours in group P, decrease in iron levels at 24th and 48th hours in all groups and no changes in copper levels in all groups were observed.At the end of the study, according to the markers of MDA and GPx, it was concluded that maintenance of general anesthesia with propofol activated the antioxidant system against oxidative stress and reduced selenium and zinc levels according to use of antioxidant system; maintenance of general anesthesia with sevoflurane activated the antioxidant system against oxidative stress and reduced selenium levels according to use of antioxidant system; and maintenance of general anesthesia with desflurane had no effects on oxidative stress and antioxidant system and thus did not change trace element levels; however, all of three methods reduced iron levels.