The intraoperative effect of pentoxifylline on the inflammatory process and leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass.
BACKGROUND
Inflammation plays a pivotal role in the pathogenesis of organ dysfunction after cardiopulmonary bypass (CPB). The aim of this study was to investigate whether pentoxifylline (PTX) has effects on the inflammatory process and leukocytes in cardiac surgery patients undergoing CPB.


METHODS
A double-blind, prospective, randomized, placebo-controlled study was undertaken to assess the effect of PTX on leukocyte counts, tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C-reactive protein (CRP) levels in 60 patients undergoing CPB for elective coronary artery bypass grafting. In 30 patients, 200 mg of PTX was added to 500 mL NaCl and perfused for 180 min after induction of anaesthesia and also 100 mg of PTX was added to the warm cardioplegic solution; another 30 patients received saline solution as placebo.


RESULTS
All measurements were performed before PTX infusion (T0), after induction of anaesthesia (T1), 30 min after weaning from CPB (T2), and 6 hours (T3) and 24 hours postoperatively (T4). PTX did not change the percentage of eosinophils, basophils, neutrophils, monocytes, or lymphocytes, or CRP levels. In the control group, however, total leukocyte count and IL-6 level at T3 and T4 period were significantly higher than the study group. The progressive increment in TNF-alpha level observed at each period was also significantly prominent in the control group.


CONCLUSIONS
CPB-related whole body inflammatory response could be partially inhibited by intraoperative PTX administration. This effect of PTX would be helpful in preventing the well-known complications of CPB-induced systemic inflammation.
Cağli
Kerim
K
Türkiye Yüksek Ihtisas Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. kerimcagli@hotmail.com
Ulaş
Mahmut Mustafa
MM
Ozişik
Kanat
K
Kale
Arzum
A
Bakuy
Vedat
V
Emir
Mustafa
M
Balci
Mustafa
M
Topbaş
Murat
M
Sener
Erol
E
Taşdemir
Oğuz
O
D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000494:pharmacology; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D007432:Intraoperative Period; D007958:Leukocyte Count; D007962:Leukocytes / Q000187:drug effects*; D008875:Middle Aged; D010431:Pentoxifylline / Q000494:pharmacology*; D010919:Placebos; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D004791:Enzyme Inhibitors; D015850:Interleukin-6; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D010431:Pentoxifylline