Impact of different anesthetic protocols during anesthesia for the establishment of a porcine model of acute kidney injury

Abstract

Background: During the establishment of a model of acute kidney injury (AKI) in pigs, we observed a high prevalence of malignant hyperthermia (MH). These complications led us to refine the anesthetic protocol. This publication describes the impact of the choice of anesthetics on the results obtained.

Methods: Pigs were euthanized at the end of the procedure, without recovery from anesthesia. Three anesthetic protocols were used: sevoflurane inhalation (ProtocolA, n = 5), a combination of ketamine, medetomidine and diazepam by intravenous infusion (ProtocolB, n = 5), and a combination of ketamine, diazepam, medetomidine, glucose, and noradrenaline (ProtocolC, n = 5). All pigs received morphine for analgesia. AKI was induced by interrupting renal perfusion for 90 min. MH was diagnosed based on clinical and biological parameters.

Results: All MH pigs belonged to ProtocolA. MH pigs showed significantly higher maximum rectal temperature (p = 0.04), maximum expired carbon dioxide (CO₂; p = 0.04), maximum heart rate (HR; p = 0.03), plasma concentration of creatinine and potassium (p < 0.0001). Protocol A pigs had a significantly higher maximum HR (p = 0.01) and hyperkalemia compared to the two other groups (ProtocolB, p = 0.005 and ProtocolC, p < 0.0001). Pigs from ProtocolA had a significantly lower minimum mean arterial pressure (MAP) than ProtocolC group (p = 0.03) and MAP remained below 60 mmHg for longer (p = 0.004). In ProtocolB, minimum glycemia was lower than other groups (p = 0.01).

Conclusion: Sevoflurane use was associated with the occurrence of MH, hemodynamic alterations and changes in plasma concentration of creatinine and potassium. These modifications can have a major impact on the validation of an experimental AKI model.

Keywords

acute kidney injury / anesthesia / ketamine / malignant hyperthermia / sevoflurane

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