Inhibition of systemic inflammatory response with sodium nitroprusside in open heart surgery.
BACKGROUND
A nitric oxide donor, sodium nitroprusside has been reported to reduce the inflammatory response during cardiopulmonary bypass (CPB). To investigate this, a double-blind and prospective study was conducted.


METHODS
Twenty patients with multi vessel coronary disease were randomly chosen to form study (SNP) and control groups. In the SNP group, 0.5 microg/kg/min sodium nitroprusside were administered for 20 min right after the release of the aortic crossclamp. Mac-1 (CD11b/CD18) leukocyte adhesion molecule expressions, interleukin-6 levels were measured from radial artery blood as well as leukocyte and platelet counts in both groups at 6 different time points: a) before anesthesia, b) after heparin administration, c) after aortic crossclamp release, d) after protamine administration, e) 3 hours after the termination of CPB, f) 24 hours after the termination of CPB.


RESULTS
The increase in Mac-1 expressions were not different between the two groups at any time point except the measurements after the administration of protamine. At this time point, Mac-1 expressions were not different between the groups (99.8+/-30.7 vs 134.6+/-95.1%, p=0.076), but higher when compared with the preinduction levels. IL-6 levels for SNP and control groups was 89+/-43 and 215+/-131 pg/dL, respectively (p=0.016) 3 hours after the termination of CPB. Twenty-four hours after the termination of CPB, IL-6 levels were still significantly higher in the control group (47+/-27 vs 111+/-68 pg/dL, p=0.039). Leukocyte and platelet counts were not different at any time point between the groups.


CONCLUSIONS
Systemic inflammatory response in patients undergoing CPB can be reduced to a certain level with sodium nitroprusside, especially the activation of vascular endothelial cells can be inhibited, but activation of leukocytes still takes place.
Göl
M K
MK
Cardiovascular Surgery Clinic, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. nkgol@ada.net.tr
Nisanoğlu
V
V
Işcan
Z
Z
Balci
M
M
Kandemir
O
O
Taşdemir
O
O
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood*; D007262:Infusions, Intravenous; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007430:Intraoperative Care; D007958:Leukocyte Count; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage*; D010976:Platelet Count; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D018836:Inflammation Mediators; D015850:Interleukin-6; D018799:Intercellular Adhesion Molecule-1; D009599:Nitroprusside