• Journal of Chest Surgery
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• v.31 no.5
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• pp.502-508
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• 1998

Proinflammatory cytokines such as tumor necrosis factor-$\alpha$(TNF-$\alpha$) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass(CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group(n=10), corticosteroid(dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group(n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-$\alpha$ bioassays. We have checked EKG, cardiac enzymes(CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day(CPK; 1122$\pm$465 vs 567$\pm$271, 864$\pm$42 vs 325$\pm$87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day(106.4$\pm$115.1 vs 29.5$\pm$22.4)(P=0.02). Arterial tumor necrosis factor-$\alpha$ rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping(ACC-5min) in steroid group(11.9$\pm$4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass(CPB-5min) in control group(22.3$\pm$6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.817-826
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• 2004

Background: Several studies have demonstrated that conventional hypothermic cardiopulmonary bypass (CPB) causes cellular injury, abnormal responses in peripheral vascular beds and increased postoperative bleeding, whereas normothermic CPB provides protection of the hypothermic-induced effects and better cardiac recovery. The present study was prospectively performed to compare the effects of normothermic CPB to those of hypothermic CPB on the inflammatory and hematologic responses during cardiac surgery. Material and Method: Thirty-four adult patients scheduled for elective cardiac surgery were randomly assigned to hypothermic CPB (nasopharyngeal temperature $26～28^{\circ}C,$ n=17) or normothermic CPB (nasopharyngeal $temperature>35.5^{\circ}C,$ n=17) group. In both groups, cold $(4^{\circ}C)$ crystalloid cardioplegia was applied for myocardial protection. Blood samples were drawn from radial artery before (Pre-CPB), 10 minutes after starting (CPB-10) and immediately after ending (CPB-OFF) CPB. Total leukocyte and platelet counts, interleukin-6 (IL-6) level(expressed as percent to the baseline of Pre-CPB), D-dimer level, protein C and protein S activity were measured with the blood samples. The amount of bleeding for postoperative 24 hours and blood transfusion after operation were also assessed. All parameters were compared between the two groups. Result: The total leukocyte counts $(10,032\pm65/mm^3)$ and the increased ratio of IL-6 $(353\pm7.0%)$ at CPB-OFF in the normothermic group were higher than that $(7,254\pm48/mm^3$ and $298\pm7.3%)$ of the hypothermic group(p=0.02 and p=0.03). In the normothermic group, protein C activity $(32\pm3.8%)$ and protein S activity $(35\pm4.1%)$ at CPB-OFF were significantly lower than that $(45\pm4.3%$ and $51\pm3.8%)$ of the hypothermic group (p=0.04 and p=0.009). However, there were no differences in platelet counts and D-dimer concentration. In the normothermic group, the amount of bleeding for postoperative 24 hours $(850\pm23.2$ mL) and requirements for blood transfusion after operation such as packed cell $(1,402\pm20.5$ mL), fresh frozen plasma $(970\pm20.8$ mL) and platelet $(252\pm6.4$ mL) were higher than that $(530\pm21.5$ mL, $696\pm15.7$ mL, $603\pm18.2$ mL and $50\pm0.0$ mL) of the hypothermic group. Conclusion: These results indicate that normothermic CPB with cold crystalloid cardioplegia was associated with higher increase in inflammatory response, hemostatic abnormalities and postoperative bleeding problem than moderate hypothermic CPB.