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Abstract
This study was designed in vivo to compare the apoptotic effect of isoflurane versus sevoflurane on human cells especially hepatocytes and to figure out the rule of insulin infusion as anti-apoptotic agent in modulation of such effect evidenced by immune histo-chemical study of liver biopsy and serum apoptotic (Fas, Fas - L, annexin V, caspase 3, 7 and 9) and (Bcl - xl, Akt) anti - apoptotic markers activity. Eighty (ASA I) patients who were scheduled for laparoscopic cholecystectomy surgery were randomly allocated into 4 groups (20 patients each). Forty patients were anesthetized with isoflurane (I groups) and the other forty received sevoflurane as an anesthetic agent (S groups). Both Isoflurane and sevoflurane groups were subdivided into control groups receiving ringer infusion (Ic and Sc groups) and insulin groups received GIK infusion (Ii and Si). Both infusions were received 1 hr before anesthetic induction. For all patients in the four groups liver biopsy was taken before the umbilical port closure. Venous blood samples (3ml) were collected at (T0 before infusion), (T1 at the end of the surgery) and (T24 one day after) for the assessment of the apoptotic biomarkers. Serum K was investigated at T0 and T1 and blood glucose level was closely monitored. At T1and T24, serum Akt and Bcl - xl levels increased significantly in Ii and Si groups compared to Ic and Sc groups respectively (p < 0.05). While in liver biopsy only Akt increased significantly in Ii group compared to Ic group (p < 0.05). Caspase 3 level decreased significantly in both serum (at T1and T24) and liver biopsy of both Ii and Si groups compared to Ic and Sc groups respectively (p < 0.05) as well as caspase 7 level which also decreased significantly in both serum (at T1and T24) and liver biopsy of Ii group compared to Ic group (p < 0.05). In Sc group serum AkT level at T1 showed significant increase compared to Ic group p < 0.05