title: Plasma nitrate/nitrite (NOx) is not a useful biomarker to predict inherent cardiopulmonary bypass inflammatory response.
abstract: OBJECTIVE
  There were strong evidences that nitric oxide has capital importance in the progressive vasodilatation associated with varied circulatory shock forms, including systemic inflammatory response syndrome (SIRS), in patients undergoing cardiac surgeries for cardiopulmonary bypass (CPB). If CPB procedures, per se, are the inciting stimulus for inflammation, plasma nitrate/nitrite (NOx) excretion would be expected to be higher in these patients rather than in patients operated without CPB. In consequence, we hypothesized that increased levels of NOx would be predictive for vasoplegic syndrome.
  
  
  METHODS
  Thirty patients were assigned to three groups: Group 1--coronary artery bypass graft (CABG) roller pump CPB; Group 2--CABG centrifugal vortex pump CPB; and Group 3--heart valve surgery roller pump CPB. Sampling of venous blood for chemiluminescence plasma NOx dosage was achieved at the following time points: (1) before anesthesia induction; (2) after anesthesia induction; (3) before heparin infusion; (4) after heparin infusion; (5) CPB-30 minutes; (6) CPB-60 minutes; (7) before protamine infusion; (8) after protamine infusion; and (9) on return to the recovery area.
  
  
  RESULTS
  There were no intergroup differences regarding age and anesthetic regimen, and the number of arteries grafted was not different between the CABG groups. There were no NOx statistic differences, neither among the three groups of patients or among the surgery time. In addition, there was no correlation among NOx, lactate, and hemoglobin.
  
  
  CONCLUSIONS
  Considering the inflammatory process intrinsic to CPB, this study reinforces the idea that plasma NOx is not useful as a biomarker of inflammatory response onset, which may or may not lead to SIRS and/or vasoplegic syndrome.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine,University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Viaro
authors.forename: Caroline Floreoto
authors.initials: CF
authors.lastname: Baldo
authors.forename: Verena Kise
authors.initials: VK
authors.lastname: Capellini
authors.forename: Andrea Carla
authors.initials: AC
authors.lastname: Celotto
authors.forename: Solange
authors.initials: S
authors.lastname: Bassetto
authors.forename: Alfredo José
authors.initials: AJ
authors.lastname: Rodrigues
authors.forename: Paulo Roberto Barbosa
authors.initials: PR
authors.lastname: Evora
mesh_terms: D000769:Anesthesia, Inhalation; D000925:Anticoagulants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation; D001026:Coronary Artery Bypass; D006351:Heart Valves / Q000601:surgery; D006454:Hemoglobins / Q000032:analysis; D006493:Heparin / Q000008:administration & dosage; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008163:Luminescent Measurements; D009566:Nitrates / Q000097:blood*; D009573:Nitrites / Q000097:blood*; D011479:Protamines / Q000008:administration & dosage; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D006454:Hemoglobins; D006494:Heparin Antagonists; D009566:Nitrates; D009573:Nitrites; D011479:Protamines; D019344:Lactic Acid; D006493:Heparin