The effects of propofol on lipid peroxidation and inflammatory response in elective coronary artery bypass grafting.
OBJECTIVE
To determine whether the antioxidant and anti-inflammatory properties of propofol confer benefit in adult patients undergoing elective coronary artery bypass grafting.


METHODS
Prospective, blinded, randomized, controlled clinical investigation.


METHODS
Single-center, university teaching hospital and academic research laboratory.


METHODS
Twenty-one adult patients (11 control, 10 intervention) with chronic stable angina and normal ventricular function scheduled to undergo elective coronary artery bypass grafting.


METHODS
All patients received a standardized fentanyl-isoflurane anesthetic. Fifteen minutes before reperfusion, patients in the intervention group received a target-controlled infusion of propofol, continued for 4 hours after cross-clamp release. Patients in the control group received saline administered in a similar fashion.


METHODS
Serum concentration of malondialdehyde (MDA) (from systemic and coronary sinus blood); systemic concentrations of interleukins 4, 6, 8, and 10; and systemic leukocyte functions (respiratory burst, phagocytosis, and beta(2) integrin expression) were measured up to 36 hours after reperfusion.


RESULTS
A high serum malondialdehyde concentration was detected in the coronary sinus in control patients, 10 minutes after reperfusion; serum malondialdehyde was not detected in the coronary sinus at this time in patients who received propofol (41.4 [15.6-1,150] micromol/L v 0, p = 0.004). Interleukin-8 concentrations increased 2 and 4 hours after reperfusion in the control group. Interleukin-6 concentrations were greater in the control group than the propofol group 4 hours after clamp release (289.1 [165.2-561] rhog/mL v 153.2 (58.2-280.3) rhog/mL, respectively, p = 0.003). Mean dose of propofol was 31.7 mg/kg during the study period.


CONCLUSIONS
Clinically relevant concentrations of propofol may attenuate free radical-mediated and inflammatory components of myocardial reperfusion injury in patients undergoing elective coronary artery bypass graft surgery.
Corcoran
Tomas B
TB
Department of Anaesthesia, University College Cork, Cork City, Republic of, Ireland. mascor@gofree.indigo.ie
Engel
Arnth
A
Sakamoto
Hidetoshi
H
O'Callaghan-Enright
Sheila
S
O'Donnell
Aonghus
A
Heffron
James A
JA
Shorten
George
G
D000368:Aged; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000494:pharmacology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D001026:Coronary Artery Bypass / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D018836:Inflammation Mediators / Q000097:blood; D007378:Interleukins / Q000097:blood; D007530:Isoflurane / Q000627:therapeutic use; D007962:Leukocytes / Q000187:drug effects; D015227:Lipid Peroxidation / Q000187:drug effects*; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators; D007378:Interleukins; D008315:Malondialdehyde; D007530:Isoflurane; D005283:Fentanyl; D015742:Propofol