A review of anti-inflammatory strategies in cardiac surgery.
It is generally accepted that cardiac surgery is frequently associated with the development of systemic inflammatory response. This phenomenon is very variable clinically, and can be detected by measuring plasma concentrations of certain inflammatory markers. Complement component, cytokines and adhesion molecules are examples of these markers. Systemic inflammation can be potentially damaging to major organs. Several anti-inflammatory strategies have been used in recent years, aiming to attenuate the development of systemic inflammatory response. This article summarizes recently published literature concerning the use of anti-inflammatory techniques and pharmacological agents in cardiac surgery. In particular, the anti-inflammatory effects of off-pump surgery, leukocyte filtration, corticosteroids, aprotinin, phosphodiesterase inhibitors, dpoexamine, H2 antagonists and ACE inhibitors are reviewed. The overall conclusion is that although certain strategies reduce plasma levels of inflammatory mediators, convincing evidence of significant clinical benefits is yet to come.
Asimakopoulos
George
G
Cardiothoracic Surgery, West London Rotation, UK. geoasi@hotmail.com
Gourlay
Terence
T
D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007611:Aprotinin / Q000494:pharmacology / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D004298:Dopamine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007962:Leukocytes / Q000187:drug effects / Q000378:metabolism; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000806:Angiotensin-Converting Enzyme Inhibitors; D000893:Anti-Inflammatory Agents; D006635:Histamine H2 Antagonists; D018836:Inflammation Mediators; D010726:Phosphodiesterase Inhibitors; C046318:dopexamine; D007611:Aprotinin; D004298:Dopamine