Xenon triggers pro-inflammatory effects and suppresses the anti-inflammatory response compared to sevoflurane in patients undergoing cardiac surgeryReport as inadecuate




Xenon triggers pro-inflammatory effects and suppresses the anti-inflammatory response compared to sevoflurane in patients undergoing cardiac surgery - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 19:365

First Online: 15 October 2015Received: 21 May 2015Accepted: 27 September 2015

Abstract

IntroductionCardiac surgery encompasses various stimuli that trigger pro-inflammatory mediators, reactive oxygen species and mobilization of leucocytes. The aim of this study was to evaluate the effect of xenon on the inflammatory response during cardiac surgery.

MethodsThis randomized trial enrolled 30 patients who underwent elective on-pump coronary-artery bypass grafting in balanced anaesthesia of either xenon or sevoflurane. For this secondary analysis, blood samples were drawn prior to the operation, intra-operatively and on the first post-operative day to measure the pro- and anti-inflammatory cytokines interleukin-6 IL-6, interleukin-8-C-X-C motif ligand 8 IL-8-CXCL8, and interleukin-10 IL-10. Chemokines such as C-X-C motif ligand 12- stromal cell-derived factor-1α CXCL12-SDF-1α and macrophage migration inhibitory factor MIF were measured to characterize xenon’s perioperative inflammatory profile and its impact on migration of peripheral blood mononuclear cells PBMC.

ResultsXenon enhanced the postoperative increase of IL-6 compared to sevoflurane Xenon: 90.7 versus sevoflurane: 33.7 pg-ml; p = 0.035 and attenuated the increase of IL-10 Xenon: 127.9 versus sevoflurane: 548.3 pg-ml; p = 0.028. Both groups demonstrated a comparable intraoperative increase of oxidative stress intra-OP: p = 0.29; post-OP: p = 0.65. While both groups showed an intraoperative increase of the cardioprotective mediators MIF and CXCL12-SDF-1α, only MIF levels decreased in the xenon group on the first postoperative day 50.0 ng-ml compared to 23.3 ng-ml; p = 0.012, whereas it remained elevated after sevoflurane anaesthesia 58.3 ng-ml to 53.6 ng-ml. Effects of patients’ serum on chemotactic migration of peripheral mononuclear blood cells taken from healthy volunteers indicated a tendency towards enhanced migration after sevoflurane anaesthesia p = 0.07.

ConclusionsCompared to sevoflurane, balanced xenon anaesthesia triggers pro-inflammatory effects and suppresses the anti-inflammatory response in cardiac surgery patients even though the clinical significance remains unknown.

Trial registrationThis clinical trial was approved by the European Medicines Agency EudraCT-number: 2010-023942-63 and at ClinicalTrials.gov NCT01285271; first received: January 24, 2011.

AbbreviationsBfArMBundesinstitut für Arzneimittel und Medizinprodukte, Germany

BISbispectral index

BSAbovine serum albumin

CPBcardiopulmonary bypass

CXCL12-SDF-1αstromal cell-derived factor 1α

ELISAenzyme-linked immunosorbent assay

ICUIntensive Care Unit

ILinterleukin

intra-OPtime point immediately before termination of surgery

MIFmacrophage migration inhibitory factor

MVmillivolts

NMDAN-methyl-d-aspartate

ORPoxidation-reduction potential

PBMCperipheral blood mononuclear cells

PBSphosphate-buffered saline

post-OP24 hours after surgery

pre-OPbaseline; time point before induction of anaesthesia

rpmrevolutions per minute

Sevsevoflurane

Xexenon

Thomas Breuer and Christoph Emontzpohl contributed equally to this work.

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-015-1082-7 contains supplementary material, which is available to authorized users.

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Author: Thomas Breuer - Christoph Emontzpohl - Mark Coburn - Carina Benstoem - Rolf Rossaint - Gernot Marx - Gereon Schälte - Juer

Source: https://link.springer.com/



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