| Abstract: | Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in theimmune system accompanied by an increase in proinflammatory cytokines and a decreasein anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as ananesthetic adjuvant modulates the inflammatory response after coronary artery bypassgraft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients(4 females and 8 males, age range 42-72) were assigned to DEX group and compared witha conventional total intravenous anesthesia (TIVA) group of 11 patients (4 femalesand 7 males). The endpoints used to assess inflammatory and biochemical responses tomini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumornecrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatinephosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variableswere determined before anesthesia, 90 min after beginning CPB, 5 h after beginningCPB, and 24 h after the end of surgery. Endpoints of oxidative stress, includingthiobarbituric acid reactive species and delta-aminolevulinate dehydratase activityin erythrocytes were also determined. DEX+TIVA use was associated with a significantreduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA(two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acidreactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01;two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB(P<0.001), but there was no difference between the two groups. DEX as an adjuvantin anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB.These findings indicate an interesting anti-inflammatory effect of DEX, which shouldbe studied in different types of surgical interventions. |
