Effects of Sevoflurane on Cytokine Balance in Patients Undergoing Coronary Artery Bypass Graft Surgery

Kawamura, Takae; Kadosaki, Mamoru; Nara, Noriko; Kaise, Atsushi; Suzuki, Hirotaka; Endo, Shigeatu; Wei, Jicheng; Inada, Katsuya

doi:10.1053/j.jvca.2006.01.011

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 4 , Pages 503-508, August 2006

Effects of Sevoflurane on Cytokine Balance in Patients Undergoing Coronary Artery Bypass Graft Surgery

Takae Kawamura, MD, PhD
- Department of Anesthesiology, Sendai Medical Center, Miyagi, Japan
- Address reprint requests to Takae Kawamura, MD, PhD, Sendai Medical Center, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
Mamoru Kadosaki, MD, PhD
- Department of Anesthesiology, Iwate Medical University Memorial Heart Center, Iwate, Japan
Noriko Nara, MD
- Department of Anesthesiology, Iwate Medical University Memorial Heart Center, Iwate, Japan
Atsushi Kaise, MD, PhD
- Department of Anesthesiology, Sendai Medical Center, Miyagi, Japan
Hirotaka Suzuki, DD, PhD
- Department of Anesthesiology, Sendai Medical Center, Miyagi, Japan
Shigeatu Endo, MD, PhD
- Department of Critical Care Medicine, Iwate Medical University, Iwate, Japan
Jicheng Wei, MD, PhD
- Department of Anesthesiology, Iwate Medical University Memorial Heart Center, Iwate, Japan
Katsuya Inada, PhD
- Department of Biology, Iwate Medical University, Iwate, Japan.

published online 24 April 2006.

Objective: The effects of sevoflurane on proinflammatory cytokines related to ischemic-reperfusion injury are not clear. The hypothesis was tested that sevoflurane decreases myocardial ischemic-reperfusion injury by suppressing proinflammatory cytokines.

Design: Prospective, randomized study.

Setting: A medical university heart center.

Participants: Twenty-three patients undergoing coronary artery bypass surgery allocated randomly into 2 groups

Interventions: Anesthesia for 23 patients undergoing coronary artery bypass surgery was maintained using either fentanyl (30 μg/kg) with propofol (2-8 mg/kg/h) in the control group (n = 10) or fentanyl (30 μg/kg) with 0.5% to 1.0% sevoflurane in the sevoflurane group (n = 13).

Measurements and Main Results: Interleukin (IL)-6, IL-8, IL-10, and IL-1 receptor antagonist (IL-1ra) were measured by enzyme-linked immunosorbent assay. Troponin-T and creatine kinase-MB isoenzyme (CK-MB) were measured by enzyme immunoassay and ultraviolet absorption spectrophotometry, respectively. Serum IL-6 and IL-8 concentrations in both groups increased significantly over baseline from 60 minutes after declamping the aorta (p < 0.001). The increases were greater in the control group than in the sevoflurane group (p < 0.05). Serum IL-10 and IL-1ra concentrations in both groups increased significantly over baseline from 60 minutes after declamping the aorta (p < 0.001). There were no differences between the two groups. Serum troponin-T and CK-MB concentrations increased significantly in both groups from 60 minutes after declamping the aorta (p < 0.001); the increases were greater in the control group (p < 0.05).

Conclusion: Sevoflurane suppressed the production of IL-6 and IL-8, but not IL-10 and IL-1ra. Changes in the balance between pro- and anti-inflammatory cytokines may be one of the most important mechanisms of myocardial protection caused by sevoflurane.

Key words: coronary artery bypass graft , cytokine balance , sevoflurane , myocardial reperfusion injury , inflammatory response , myocardial protection