Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Moléculas de Adhesión Celular/análisis , Granulocitos/metabolismo , Oxígeno/sangre , Anestesia , Líquido del Lavado Bronquioalveolar/química , Antígenos CD18/análisis , Puente Cardiopulmonar , Quimiocina CCL2/análisis , Niño , Preescolar , Femenino , Humanos , Lactante , Mediadores de Inflamación/análisis , Interleucina-10/análisis , Interleucina-8/análisis , Selectina L/análisis , Linfocitos/metabolismo , Antígeno de Macrófago-1/análisis , Masculino , Monocitos/metabolismo , Oxígeno/fisiología , Presión Parcial , Periodo PosoperatorioRESUMEN
We examined the effect of aprotinin on the production of interleukin-8 and the expression of leukocyte adhesion molecules in an isolated cardiopulmonary bypass circuit. Five healthy volunteers each donated 500 ml blood which was divided into equal portions (A) and (B). Portion A was treated with aprotinin 250000 kallikrein inactivator units and added to a circuit primed with a further 250000 kallikrein inactivator units. Portion B was simultaneously treated with 25 ml normal saline and added to an aprotinin-free circuit. Samples of blood were taken at donation, after addition of a drug and at 30-min intervals throughout isolated cardiopulmonary bypass. The interleukin-8 increase was smaller in the aprotinin group but the difference between groups was not statistically significant (p > 0.05). In contrast, aprotinin inhibited the cardiopulmonary bypass-induced increase in monocyte (p < 0.05) and granulocyte (p < 0.01) CD18 and the increase in granulocyte, but not monocyte, CD11b (p < 0.05). Cardiopulmonary bypass had little effect on expression of L-selectin. These results confirm that aprotinin attenuates leukocyte activation during isolated cardiopulmonary bypass.
Asunto(s)
Aprotinina/farmacología , Puente Cardiopulmonar , Hemostáticos/farmacología , Interleucina-8/sangre , Inhibidores de Serina Proteinasa/farmacología , Antígenos CD18/sangre , Humanos , Selectina L/sangre , Leucocitos/efectos de los fármacos , Leucocitos/metabolismo , Antígeno de Macrófago-1/sangreAsunto(s)
Interleucina-8/metabolismo , Isquemia Miocárdica/cirugía , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Factor de Necrosis Tumoral alfa/metabolismo , Adulto , Biomarcadores , Líquido del Lavado Bronquioalveolar , Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Femenino , Humanos , Masculino , Isquemia Miocárdica/metabolismo , Síndrome de Dificultad Respiratoria/metabolismo , Sensibilidad y EspecificidadRESUMEN
UNLABELLED: Outcome in some diseases is determined by the relationship between pro- and antiinflammatory cytokines. Surgery may also provoke a cytokine response, which has both pro- and antiinflammatory components. The aim of this study was to ascertain whether anesthetic technique can modify the balance of cytokines associated with abdominal surgery. Twenty patients scheduled to undergo elective abdominal hysterectomy were randomly allocated to receive maintenance of anesthesia with isoflurane (IH group) or propofol (IV group). Venous blood samples for measurement of tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-1 receptor antagonist (IL-1ra) were taken before the induction of anesthesia and at set intervals until 24 h postoperatively. TNF-alpha levels remained low throughout the study; however, all patients showed a significant postoperative increase in IL-6, IL-10, and IL-1ra (P < 0.05). Levels of the proinflammatory cytokine IL-6 were similar in both groups, whereas the antiinflammatory cytokine IL-10 was higher in the IV group at 4 h postoperatively (P < 0.02). The difference between groups in terms of IL-1ra production just failed to reach significance (P < 0.06). We conclude that the cytokine response to abdominal surgery has both pro- and antiinflammatory components and that the choice of anesthetic may modify the balance of these cytokines. IMPLICATIONS: This study demonstrates that in addition to the widely reported proinflammatory cytokine response, elective abdominal surgery provokes an antiinflammatory response, which may be enhanced by total intravenous anesthesia. The ability of anesthetics to modify the cytokine response to surgery may have therapeutic potential.
Asunto(s)
Anestesia , Anestésicos por Inhalación/farmacología , Anestésicos Intravenosos/farmacología , Citocinas/sangre , Histerectomía , Isoflurano/farmacología , Propofol/farmacología , Adulto , Femenino , Humanos , Mediadores de Inflamación/sangre , Interleucina-10/sangre , Interleucina-6/sangre , Persona de Mediana Edad , Receptores de Interleucina-1/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/análisisRESUMEN
The effect of a bolus and continuous infusion of midazolam on postoperative morphine consumption was assessed in a placebo-controlled, double-blind, randomly allocated trial of 50 patients undergoing elective abdominal hysterectomy. Patients in the trial group received a bolus dose of midazolam 5 mg.70 kg-1 at induction followed by an infusion at a rate of 1 mg.70 kg-1.h-1 over the next 48 h. Morphine consumption in the midazolam group was significantly lower in the first 12 h postoperatively (p < 0.02) but there was no significant difference between the two groups thereafter. Patients in the midazolam treated group had lower pain scores over the first 24 h. Also, a significantly greater number of patients in the midazolam group required no antiemetic medication over the 48 h study period (p < 0.05). Assessment of sedation revealed no significant difference between groups. We conclude that low dose midazolam has a significant, but short-lived, morphine sparing effect.