Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T15:17:25.260Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of sevoflurane on the ex vivo secretion of TNF-α during and after coronary artery bypass surgery

Published online by Cambridge University Press:  30 June 2005

S. R. El Azab ,
P. M. J. Rosseel ,
J. J. De Lange ,
A. B. J. Groeneveld ,
R. Van Strik ,
E. M. Van Wijk  and
G. J. Scheffer
S. R. El Azab
Affiliation:
Amphia Hospital, Department of Anaesthesia and Intensive Care, Breda, The Netherlands Vrjie Universiteit Medical Centre, Department of Anaesthesia, Amsterdam, The Netherlands
P. M. J. Rosseel
Affiliation:
Amphia Hospital, Department of Anaesthesia and Intensive Care, Breda, The Netherlands
J. J. De Lange
Affiliation:
Vrjie Universiteit Medical Centre, Department of Anaesthesia, Amsterdam, The Netherlands
A. B. J. Groeneveld
Affiliation:
Vrjie Universiteit Medical Centre, Department of Intensive Care, Amsterdam, The Netherlands
R. Van Strik
Affiliation:
Erasmus University Medical School, Department of Epidemiology and Biostatistics, Rotterdam, The Netherlands
E. M. Van Wijk
Affiliation:
Amphia Hospital, Department of Anaesthesia and Intensive Care, Breda, The Netherlands
G. J. Scheffer
Affiliation:
Amphia Hospital, Department of Anaesthesia and Intensive Care, Breda, The Netherlands
Get access

Extract

Summary

Background and objective: Sevoflurane has been used for the induction and maintenance of anaesthesia during cardiac surgery owing to its favourable haemodynamic effects. It has been suggested that it offers protection against myocardial ischaemia–reperfusion injury.

Methods: We investigated the effect of sevoflurane on plasma concentrations of tumour necrosis factor-α (TNF-α) after ex vivo stimulation of whole-blood leukocytes by lipopolysaccharide from 20 patients undergoing coronary artery bypass surgery. The patients were randomized to two groups. Group 1 patients were induced and maintained with sevoflurane; those in Group 2 were anaesthetized with moderate doses of midazolam–sufentanil. Blood samples were drawn from the patients on seven occasions from before induction of anaesthesia until 24 h after skin closure.

Results: Plasma concentrations of TNF-α were lower in Group 1 than in Group 2 after cessation of cardiopulmonary bypass (median (interquartiles): 25 (21–30) versus 37 (28–79) pg mL−1; P < 0.05) and 24 h after skin closure (196 (100–355) versus 382 (233–718) pg mL−1; P < 0.05). Postoperatively, two cases of myocardial infarction were recorded, one in each group. Six patients in Group 2 needed continued inotropic support after the first morning to maintain haemodynamic stability versus one patient in Group 1 (P < 0.05). The length of stay in the intensive care unit was significantly lower in Group 1 than in Group 2 (mean ± SD: 25 ± 16 versus 54 ± 30 h; P < 0.05).

Conclusions: Sevoflurane reduces production of TNF-α more than total intravenous anaesthesia with midazolam–sufentanil during cardiac surgery. This may reduce cardiac morbidity and the length of stay in the intensive care unit.

Keywords

ANAESTHETICS GENERAL, anaesthetics inhalation, sevofluraneIMMUNOLOGICAL FACTORS, cytokines, monokines, tumour necrosis factorMYOCARDIAL REVASCULARIZATION, coronary artery bypass
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 5 , May 2003 , pp. 380 - 384
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

El Azab SR, Scheffer GJ, Rosseel PMJ, de Lange JJ. Induction and maintenance of anaesthesia with sevoflurane in comparison to high dose opioid during coronary artery bypass surgery. Eur J Anaesthesiol 2000; 17: 336–338.Google Scholar
Gravel NR, Searle NR, Taillefer J, Carrier M, Roy M, Gagnon L. Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance vs TIVA in CABG surgery. Can J Anaesth 1999; 46: 240–246.Google Scholar
Novalija E, Fujita S, Kampine JP, Stowe DF. Sevoflurane mimics ischemic preconditioning on coronary flow and nitric oxide release in isolated hearts. Anesthesiology 1999; 91: 701–712.Google Scholar
Kanaya N, Kobayashi I, Nakayama M, Fujita S, Namiki A. ATP sparing effect of isoflurane during ischaemia and reperfusion of the canine heart. Br J Anaesth 1995; 74: 563–568.Google Scholar
Buljubasic N, Marijic J, Stowe DF, Kampine JP, Bosnjak ZJ. Halothane reduces dysrrhythmias and improves contractile function after global hypoperfusion in isolated hearts. Anesth Analg 1992; 74: 384–394.Google Scholar
Buljubasic N, Stowe DF, Marijic J, Roerig DL, Kampine JP, Bosnjak ZJ. Halothane reduces release of adenosine, inosine, and lactate with ischemia and reperfusion in isolated hearts. Anesth Analg 1993; 76: 54–62.Google Scholar
Toller WG, Kersten JR, Pagel PS, Hettrick DA, Warltier DC. Sevoflurane reduces myocardial infarct size and decreases the time threshold for ischemic preconditioning in dogs. Anesthesiology 1999; 91: 1437–1446.Google Scholar
Caputi AP, Squadrito F. Role of TNF-α and therapeutic perspectives in bowel and myocardial ischaemia/reperfusion injury. Pharmacol Res 1992; 26 (Suppl 2): 150–151.Google Scholar
Digel W, Porzsolt F, Schmid M, Herrmann F, Lesslauer W, Brockhaus M. High levels of circulating soluble receptors for tumour necrosis in hairy cell leukemia and type B chronic lymphocytic leukemia. J Clin Invest 1992; 89: 1690–1693.Google Scholar
Beutler BA, Milsark IW, Cerami A. Cachectin/tumour necrosis factor: production, distribution, and metabolic fate in vivo. J Immunol 1985; 135: 3972–3977.Google Scholar
Torre-Amione G, Kapadia S, Benedict C, Oral H, Young JB, Mann DL. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the studies of left ventricular dysfunction (SOLVD). J Am Coll Cardiol 1996; 27: 1201–1206.Google Scholar
Cain BS, Meldrum DR, Dinarello CA, et al. Tumour necrosis factor-α and interleukin-1β synergistically depress human myocardial function. Crit Care Med 1999; 27: 1309–1318.Google Scholar
El Azab SR, Rosseel PMJ, de Lange JJ, van Wijk EM, van Strik R, Scheffer GJ. Effect of VIMA with sevoflurane versus TIVA with propofol or midazolam–sufentanil on the cytokine response during CABG surgery. Eur J Anaesthesiol 2002; 19: 276–282.Google Scholar
Mitsuhata H, Shimizu R, Yokoyama MM. Suppressive effect of volatile anesthetics on cytokine release in human peripheral blood mononuclear cells. Int J Immunopharmacol 1995; 17: 529–534.Google Scholar
Brix-Christensen V, Tonnesen E, Sorensen IJ, Bilfinger TV, Sanchez RG, Stefano GB. Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute-phase protein responses in patients undergoing cardiac surgery. Acta Anaesthesiol Scand 1998; 42: 63–70.Google Scholar
Warner DS, McFarlane C, Todd MM, Ludwig P, McAllister AM. Sevoflurane and halothane reduce focal ischemic brain damage in the rat. Possible influence in thermoregulation. Anesthesiology 1993; 79: 985–992.Google Scholar
Werner C, Mollenberg O, Kochs E, Schulte J am Esch. Sevoflurane improves neurological outcome after incomplete cerebral ischaemia in rats. Br J Anaesth 1995; 75: 756–760.Google Scholar
Kon S. Imai M, Inaba H. Isoflurane attenuates early neutrophil-independent hypoxia–reoxygenation injuries in the reperfused liver in fasted rats. Anesthesiology 1997; 86: 128–136.Google Scholar
Zager RA, Iwata M. Inorganic fluoride. Divergent effects on human proximal tubular cell viability. Am J Pathol 1997; 150: 735–745.Google Scholar
Mullen PG, Windsor AC, Walsh CJ, et al. Combined ibuprofen and monoclonal antibody to tumour necrosis factor-α attenuate hemodynamic dysfunction and sepsis-induced acute lung injury. J Trauma 1993; 34: 612–620.Google Scholar
Wang P, Ayala A, Ba ZF, Zhou M, Perrin MM, Chaudry IH. Tumour necrosis factor-α produces hepatocellular dysfunction despite normal cardiac output and hepatic microcirculation. Am J Physiol 1993; 265: G126–G132.Google Scholar
Singh G, Chaudry KI, Morrison MH, Chaudry IH. Tumour necrosis factor depresses gut absorptive function. Circ Shock 1993; 39: 279–284.Google Scholar
Meldrum DR, Donnahoo KK. Role of TNF in mediating renal insufficiency following cardiac surgery: evidence of a postbypass cardiorenal syndrome. J Surg Res 1999; 85: 185–199.Google Scholar
Meldrum DR, Cleveland JC Jr, Sheridan BC, Rowland RT, Banerjee A, Harken AH. Cardiac surgical implications of calcium dyshomeostasis in the heart. Ann Thorac Surg 1996; 61: 1273–1280.Google Scholar
Yokoyama T, Vaca L, Rossen RD, Durante W, Hazarika P, Mann DL. Cellular basis for the negative inotropic effects of tumor necrosis factor-α in the adult mammalian heart. J Clin Invest 1993; 92: 2303–2312.Google Scholar
Gurevitch J, Frolkis I, Yuhas Y, et al. Anti-tumor necrosis factor-α improves myocardial recovery after ischemia and reperfusion. Am Coll Cardiol 1997; 30: 1554–1561.Google Scholar