title: Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date.
  
  
  METHODS
  Lornoxicam is a non steroid anti-inflammatory drug which temporally inhibits the cycloxygenase. In this clinical trial we study the effect of lornoxicam in lung inflammatory response after operations for cardiac surgery with cardiopulmonary bypass. In our study we conclude 14 volunteers patients with ischemic coronary disease undergoing coronary artery bypass grafting with EC. In seven of them 16 mg lornoxicam was administered iv before the anesthesia induction and before the connection in heart-lung machine. In control group (7 patients) we administered the same amount of normal saline.
  
  
  RESULTS
  Both groups are equal regarding pro-operative and intra-operative parameters. The inflammatory markers were calculated by Elisa method. We measured the levels of cytokines (IL-6, IL-8, TNF-a), adhesion molecules (ICAM-1, e-Selectin, p-Selectin) and matrix metaloproteinase-3 (MMP-3) just after anesthesia induction, before and after cardiopulmonary bypass, just after the patients administration in ICU and after 8 and 24 hrs. In all patients we estimated the lung's inflammatory reaction with lung biopsy taken at the begging and at the end of the operation. We calculated hemodynamics parameters: Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Pulmonary Vascular Resistance Index (PVRI), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI), and the Pulmonary arterial pressure, and respiratory parameters too: alveolo-arterial oxygen difference D (A-a), intrapulmonary shunt (Qs/Qt) and pulmonary Compliance. IL-6 levels of lornoxicam group were statistical significant lower at 1st postoperative day compared to them of control group (113±49 and 177±20 respectively, P=0.008). ICAM-1 levels were statistical significant lower at the patient admission in ICU, compared to them of control group (177±29 and 217±22 respectively, P=0.014), and the 1st postoperative day compared to them in control group (281±134 and 489±206 respectively, P=0.045). P-selectin levels were statistical significant lower, compared to them in control group in four measurements (97±23 and 119±7 respectively, P=0.030, 77±19 and 101±20 respectively, P=0.044, 86±4 and 105±13 respectively, P=0.06, 116±13 and 158±17 respectively, P=0.000).
  
  
  CONCLUSIONS
  Hemodynamics and respiratory parameters were improved compared to control group, but these differences was not statistical significant. Eosinofil adhesion and sequestration in intermediate tissue of lung parenchyma were significantly lower compared to control group. Also, alveolar edema was not noted in lornoxicam's group. Lornoxicam reduce the inflammatory response in patients undergone coronary artery bypass grafting with extracorporeal circulation. This calculated from levels reduction of IL-6, ICAM-1 και p-Selectin, and from lung pathologoanatomic examination (absence of alveolar edema, reduce in eosinofil adhesion and sequestration in intermediate tissues). Despite the favorable effect of lornoxicam on the hemodinamics and respiratory parameters these improvement did not seem to be statistical significant.
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Kosmas
authors.initials: K
authors.lastname: Tsakiridis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Vretzkakis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Mikroulis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mpakas
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kesisis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Stamatis
authors.initials: S
authors.lastname: Arikas
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kolettas
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Giorgios
authors.initials: G
authors.lastname: Moschos
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Katsikogiannis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Machairiotis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Tsiouda
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Siminelakis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beleveslis
authors.affiliation: 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
keywords: Lornoxicam; cardiac surgery; cardiopulmonary bypass; extracorporeal circulation; left ventricular stroke work index (LVSWI); pulmonary vascular resistance index (PVRI); right ventricular stroke work index (RVSWI); systemic vascular resistance index (SVRI)