Effect of N-acetylcysteine on cardiac injury and oxidative stress after abdominal aortic aneurysm repair: A randomized controlled trial.

Author(s): Mahmoud KM, Ammar AS

Affiliation(s): Anaesthesiology and ICU Department, Minoufiya Faculty of Medicine, Minoufiya, Egypt.

Publication date & source: 2011-09, Acta Anaesthesiol Scand., 55(8):1015-21.

BACKGROUND: Several studies have reported that the antioxidant properties of N-acetylcysteine (NAC) can provide cardiac protection through scavenging of free radicals. The present study was aimed to assess the efficacy of NAC for cardiac protection in patients undergoing elective abdominal aortic aneurysm (AAA) repair. METHODS: Fifty adult patients undergoing (AAA) repair were randomly allocated to receive NAC infusion (n = 25) or placebo infusion (n = 25). NAC infusion in group I (NAC group) was started at a rate of 0.3 mg/kg/min intravenously during surgery then decreased to a rate of 0.2 mg/kg/min for 24 h post-operatively. Group II (placebo group) received an equivalent rate of placebo infusion. The following parameters: myocardial-specific protein troponin-I, creatine phosphokinase-MB (CPK-MB), plasma pro-inflammatory cytokines [tumour necrosis factor-alpha (TNF-alpha) and interleukin (IL)-1beta], were assessed at the following time points: preoperatively and at 1 h, 12 h, 24 h, 48 h, and 96 h after surgery. Furthermore, serum malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured preoperatively as a baseline, during aortic clamping, 30 min after declamping, at the end of surgery, 2 h after surgery, 12 h after surgery, and 24 h after surgery. RESULTS: NAC infusion patients had significantly lower post-operative concentrations of myocardial-specific protein [cTnI, CPK-MB] and pro-inflammatory cytokines [TNF-alpha, IL-1beta]. In addition, MDA level was less and TAC was higher in patients who received NAC infusion. CONCLUSION: NAC infusion provided cardiac protection through scavenging of oxygen free radicals. (c) 2011 The Authors Acta Anaesthesiologica Scandinavica (c) 2011 The Acta Anaesthesiologica Scandinavica Foundation.