Effects of sevoflurane on cytokine balance in patients undergoing coronary artery bypass graft surgery.
OBJECTIVE
The effects of sevoflurane on proinflammatory cytokines related to ischemic-reperfusion injury are not clear. The hypothesis was tested that sevoflurane decreases myocardial ischemic-reperfusion injury by suppressing proinflammatory cytokines.


METHODS
Prospective, randomized study.


METHODS
A medical university heart center.


METHODS
Twenty-three patients undergoing coronary artery bypass surgery allocated randomly into 2 groups.


METHODS
Anesthesia for 23 patients undergoing coronary artery bypass surgery was maintained using either fentanyl (30 microg/kg) with propofol (2-8 mg/kg/h) in the control group (n = 10) or fentanyl (30 microg/kg) with 0.5% to 1.0% sevoflurane in the sevoflurane group (n = 13).


RESULTS
Interleukin (IL)-6, IL-8, IL-10, and IL-1 receptor antagonist (IL-1ra) were measured by enzyme-linked immunosorbent assay. Troponin-T and creatine kinase-MB isoenzyme (CK-MB) were measured by enzyme immunoassay and ultraviolet absorption spectrophotometry, respectively. Serum IL-6 and IL-8 concentrations in both groups increased significantly over baseline from 60 minutes after declamping the aorta (p < 0.001). The increases were greater in the control group than in the sevoflurane group (p < 0.05). Serum IL-10 and IL-1ra concentrations in both groups increased significantly over baseline from 60 minutes after declamping the aorta (p < 0.001). There were no differences between the two groups. Serum troponin-T and CK-MB concentrations increased significantly in both groups from 60 minutes after declamping the aorta (p < 0.001); the increases were greater in the control group (p < 0.05).


CONCLUSIONS
Sevoflurane suppressed the production of IL-6 and IL-8, but not IL-10 and IL-1ra. Changes in the balance between pro- and anti-inflammatory cytokines may be one of the most important mechanisms of myocardial protection caused by sevoflurane.
Kawamura
Takae
T
Department of Anesthesiology, Sendai Medical Center, Miyagi, Japan. tkawamura@snh.go.jp
Kadosaki
Mamoru
M
Nara
Noriko
N
Kaise
Atsushi
A
Suzuki
Hirotaka
H
Endo
Shigeatu
S
Wei
Jicheng
J
Inada
Katsuya
K
D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D005283:Fentanyl / Q000494:pharmacology; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007378:Interleukins / Q000097:blood*; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000517:prevention & control; D015742:Propofol / Q000494:pharmacology; D000077149:Sevoflurane; D020107:Troponin T / Q000097:blood
D018685:Anesthetics, Inhalation; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D016209:Interleukin-8; D007378:Interleukins; D008738:Methyl Ethers; D020107:Troponin T; D016753:Interleukin-10; D000077149:Sevoflurane; D052279:Creatine Kinase, MB Form; D005283:Fentanyl; D015742:Propofol