Inclusion of sevoflurane in cardioplegia reduces neutrophil activity during cardiopulmonary bypass.
OBJECTIVE
The purpose of this study was to examine the effects of sevoflurane cardioplegia on neutrophil response and complement activation after cardiopulmonary bypass (CPB).


METHODS
A prospective, randomized clinical investigation.


METHODS
University-affiliated hospital; single institutional.


METHODS
Twenty-one male patients undergoing coronary bypass surgery using CPB.


METHODS
Eleven patients were randomly assigned to receive sevoflurane 2% as a part of the cardioplegic mixture (SEV). The control group (n = 10) received no sevoflurane in their cardioplegia (control).


RESULTS
Myeloperoxidase activity (MPO) was assayed in coronary sinus blood as a surrogate for neutrophilic response at the termination of CPB. MPO activity in the coronary sinus blood was lower in the patients who received sevoflurane compared with controls. MPO activity was higher in patients with cardiac events at 4-year follow-up when compared with asymptomatic patients. IL-8, C4b, C3d, C5a, and CH50 were assessed in coronary sinus and peripheral blood at time of CPB initiation (T0) and upon the termination of CPB (T2). Peripheral blood sampling occurred at the sixth hour after T0 (T6). IL-8 levels were significantly inhibited in the SEV group when compared with controls at T2 and T6. CH50 (an index of global activation of complement system) decreased 30% at T2 and 52% at T6. The classic component of the complement pathway (C4b) was effectively inhibited in the SEV group, whereas the common pathway (C3d and C5a) was similar in both groups.


CONCLUSIONS
The addition of sevoflurane to cardioplegia is associated with an inhibition of neutrophils after CPB. A major component of the neutrophil response appears to be IL-8 mediated, although the classic complement pathway is also inhibited by sevoflurane.
Nader
Nader D
ND
VA Medical Center, Buffalo, NY 14215, USA. nnader@buffalo.edu
Karamanoukian
Hratch L
HL
Reedy
Roberta L
RL
Salehpour
Firooz
F
Knight
Paul R
PR
D002315:Cardiopulmonary Bypass; D003167:Complement Activation; D015936:Complement C5a / Q000032:analysis; D006324:Heart Arrest, Induced; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D018375:Neutrophil Activation / Q000187:drug effects*; D009195:Peroxidase / Q000097:blood; D015221:Potassium Channels / Q000502:physiology; D011446:Prospective Studies; D000077149:Sevoflurane
D016209:Interleukin-8; D008738:Methyl Ethers; D015221:Potassium Channels; D000077149:Sevoflurane; D015936:Complement C5a; D009195:Peroxidase