Original article
Effects of Sevoflurane on Cytokine Balance in Patients Undergoing Coronary Artery Bypass Graft Surgery

https://doi.org/10.1053/j.jvca.2006.01.011Get rights and content

Objective: The effects of sevoflurane on proinflammatory cytokines related to ischemic-reperfusion injury are not clear. The hypothesis was tested that sevoflurane decreases myocardial ischemic-reperfusion injury by suppressing proinflammatory cytokines.

Design: Prospective, randomized study.

Setting: A medical university heart center.

Participants: Twenty-three patients undergoing coronary artery bypass surgery allocated randomly into 2 groups

Interventions: Anesthesia for 23 patients undergoing coronary artery bypass surgery was maintained using either fentanyl (30 μg/kg) with propofol (2-8 mg/kg/h) in the control group (n = 10) or fentanyl (30 μg/kg) with 0.5% to 1.0% sevoflurane in the sevoflurane group (n = 13).

Measurements and Main Results: Interleukin (IL)-6, IL-8, IL-10, and IL-1 receptor antagonist (IL-1ra) were measured by enzyme-linked immunosorbent assay. Troponin-T and creatine kinase-MB isoenzyme (CK-MB) were measured by enzyme immunoassay and ultraviolet absorption spectrophotometry, respectively. Serum IL-6 and IL-8 concentrations in both groups increased significantly over baseline from 60 minutes after declamping the aorta (p < 0.001). The increases were greater in the control group than in the sevoflurane group (p < 0.05). Serum IL-10 and IL-1ra concentrations in both groups increased significantly over baseline from 60 minutes after declamping the aorta (p < 0.001). There were no differences between the two groups. Serum troponin-T and CK-MB concentrations increased significantly in both groups from 60 minutes after declamping the aorta (p < 0.001); the increases were greater in the control group (p < 0.05).

Conclusion: Sevoflurane suppressed the production of IL-6 and IL-8, but not IL-10 and IL-1ra. Changes in the balance between pro- and anti-inflammatory cytokines may be one of the most important mechanisms of myocardial protection caused by sevoflurane.

Section snippets

Materials and methods

The study was approved by the institutional ethics committee, and written informed consent was obtained. This prospective randomized study was performed in 24 patients of American Society of Anesthesiologists status II undergoing elective coronary artery bypass graft surgery. Study subjects were divided into a control group (n = 11), in whom anesthesia was maintained with fentanyl and propofol, and a sevoflurane group (n = 13), in whom anesthesia was maintained with fentanyl and sevoflurane.

Results

The 2 groups did not differ significantly in age, body weight, ejection fraction, number of grafts, duration of aortic clamping, or duration of CPB (Table 1). In both groups, serum IL-6 and IL-8 began to rise significantly from 60 minutes after aortic declamping compared with the preoperative baseline values and those at 60 minutes of aortic clamping (p < 0.001), respectively. However, the increases were significantly less in the sevoflurane group than in the control group (p < 0.05) (Fig 1).

Discussion

It has recently been reported that volatile halogenated anesthetics alleviate IR injury,7, 8, 9 which has partly been explained by decreased adhesion of neutrophils to the vascular endothelium and reduction of hydroxyl radicals in the coronary circulation.12 Cytokines, on the other hand, have been shown to be involved in IR injury.3, 4, 5 In an animal lung model of IR, sevoflurane was shown to decrease the production of TNF-α and to relieve neutrophil-dependent IR injury.16 It has also been

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