title: Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass.
abstract: Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72) were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA) group of 11 patients (4 females and 7 males). The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumor necrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA (two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001), but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.
authors.affiliation: Departamento de Bioquímica e Biologia Molecular, Programa de Pós-graduação em Ciências Biológicas - Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
authors.forename: N M H
authors.initials: NM
authors.lastname: Bulow
authors.affiliation: Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
authors.forename: E
authors.initials: E
authors.lastname: Colpo
authors.affiliation: Departamento de Química, Programa de Pós-graduação em Química Aplicada, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brasil.
authors.forename: R P
authors.initials: RP
authors.lastname: Pereira
authors.affiliation: Departamento de Bioquímica e Biologia Molecular, Programa de Pós-graduação em Ciências Biológicas - Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
authors.forename: E F M
authors.initials: EF
authors.lastname: Correa
authors.affiliation: Departamento de Bioquímica e Biologia Molecular, Programa de Pós-graduação em Ciências Biológicas - Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
authors.forename: E P
authors.initials: EP
authors.lastname: Waczuk
authors.affiliation: Departamento de Bioquímica e Biologia Molecular, Programa de Pós-graduação em Ciências Biológicas - Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
authors.forename: M F
authors.initials: MF
authors.lastname: Duarte
authors.affiliation: Departamento de Bioquímica e Biologia Molecular, Programa de Pós-graduação em Ciências Biológicas - Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
authors.forename: J B T
authors.initials: JB
authors.lastname: Rocha
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000771:Anesthesia, Intravenous / Q000379:methods*; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D016207:Cytokines / Q000097:blood; D020927:Dexmedetomidine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000517:prevention & control*; D017392:Thiobarbituric Acid Reactive Substances / Q000032:analysis; D013997:Time Factors; D019210:Troponin I / Q000097:blood
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D001786:Blood Glucose; D016207:Cytokines; D017392:Thiobarbituric Acid Reactive Substances; D019210:Troponin I; D020927:Dexmedetomidine; D002097:C-Reactive Protein; D003402:Creatine Kinase; D006854:Hydrocortisone