title: Biomarkers of inflammation in major vascular surgery: a prospective randomised trial.
abstract: BACKGROUND
  Surgery induces inflammation and pro-inflammatory cytokines are associated with post-operative complications. In cardiac surgery, it has been shown that volatile anaesthetics have cardioprotective properties. We explored whether sevoflurane affects the pro-inflammatory response favourably compared with total intravenous anaesthesia (TIVA) after surgery.
  
  
  METHODS
  We measured monocyte chemotactic protein 1 (MCP-1), matrix metalloproteinase 9 (MMP-9), C-reactive protein (CRP), vascular cell adhesion molecule 1 (VCAM-1), interleukin (IL)-6 and IL-8 perioperatively and evaluated if the anaesthetic regimen affected these mediators. Our hypothesis was that sevoflurane-based anaesthesia is associated with a reduced release of biomarkers of inflammation compared with TIVA with propofol/remifentanil.
  
  
  RESULTS
  In the total population, MCP-1, MMP-9, IL-6 and IL-8 increased 30 min after arrival intensive care unit, compared with before surgery (P < 0.001), whereas CRP and VCAM-1 transiently declined (P < 0.001). From 30 min after arrival intensive care unit to 1st post-operative day, MCP-1 and IL-6 levels declined (P < 0.001), CRP and VCAM-1 increased (P < 0.001), whereas MMP-9 and IL-8 were not significantly altered. Pre-operatively there were no significant differences in any variables between the two anaesthetic groups. Lower levels of MCP-1 and IL-8 (P < 0.001) and higher levels of IL-6 and MMP-9 (P = 0.003) were found in the sevoflurane group, compared with the TIVA group 30 min post-operatively. CRP and VCAM-1 levels did not differ. There were no significant differences between the two anaesthetic groups before surgery or at 1st post-operative day.
  
  
  CONCLUSIONS
  We found an inflammatory response during the observation period, which was modified by the anaesthetic regimen in the early phase. This short-lasting difference is probably too short to support a cardioprotective effect of sevoflurane compared with TIVA in open abdominal aortic surgery.
authors: Department of Anaesthesiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors: E E
authors: EE
authors: Lindholm
authors: Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors: E
authors: E
authors: Aune
authors: Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: I
authors: I
authors: Seljeflot
authors: Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors: J E
authors: JE
authors: Otterstad
authors: Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: K A
authors: KA
authors: Kirkebøen
mesh_terms: D000368:Aged; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000097:blood / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000097:blood / Q000494:pharmacology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D002316:Cardiotonic Agents / Q000097:blood; D018932:Chemokine CCL2 / Q000097:blood; D016207:Cytokines / Q000097:blood* / Q000187:drug effects; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008738:Methyl Ethers / Q000097:blood* / Q000494:pharmacology*; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies; D000077149:Sevoflurane; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D014656:Vascular Surgical Procedures
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D002316:Cardiotonic Agents; D018932:Chemokine CCL2; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D008738:Methyl Ethers; D019010:Vascular Cell Adhesion Molecule-1; D000077149:Sevoflurane; D002097:C-Reactive Protein; D020780:Matrix Metalloproteinase 9