Effects of sevoflurane on cytokine balance in patients undergoing coronary artery bypass graft surgery.

Author(s): Kawamura T, Kadosaki M, Nara N, Kaise A, Suzuki H, Endo S, Wei J, Inada K

Affiliation(s): Department of Anesthesiology, Sendai Medical Center, Miyagi, Japan. tkawamura@snh.go.jp

Publication date & source: 2006-08, J Cardiothorac Vasc Anesth., 20(4):503-8. Epub 2006 Apr 21.

Publication type: Randomized Controlled Trial

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 microg/kg) with propofol (2-8 mg/kg/h) in the control group (n = 10) or fentanyl (30 microg/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.