The influence of anesthesia components on systemic inflammatory response during cardiac surgery with cardiopulmonary bypass

Abstract

Background. There are some experimental and clinical data indicating that propofol and morphine may to reduce systemic inflammatory response (SIR) after cardiopulmonary bypass (CPB). Objectives. To study the impact of anesthetics and opioids on the SIR associated with cardiopulmonary bypass. Materials and methods. The studies examined the dynamic concentration of tumor necrosis factor (TNF), interleukin-6 (IL-6) and interleukin-8 (IL-8) before CPB, 1, 3 and 24 hours after the end of CPB in 119 patients randomized in four groups. Patients of the first group received sevoflurane and fentanyl, patients of the second group received sevoflurane and morphine, patients of the third group received propofol and fentanyl, patients of the fourth group received propofol and morphine. Results. There was found increase in cytokine level in 1 hour after CPB. In the fourth group concentration of markers was lower versus the other groups. Significant differences were found with group 1 (sevoflurane and fentanyl) in the concentration of IL-6 after 3 hours (p = 0.004) and after 24 hours (p = 0.018); IL-8 after 1 hour (p = 0.003); TNF after 1 hour (p = 0.001) and after 3 hours (p = 0.001). In the fourth group (propofol and morphine) compared with group 1 (sevoflurane and fentanyl) there was lower body temperature in 4 hours after surgery (p = 0.005) and a lower leukocyte count on the 3rd day - 8,2 (7-11,4) x10⁹/l versus 11,1 (912,6) x10⁹/l (p = 0,005), there was less length of the ICU stay - 24 (21-29) hours versus 44 (23-71) hours (p = 0.013) and the frequency of use of vasoactive medications is 13.3 % versus 46.7 % (p = 0.02). Conclusion. Our results showed the ability of propofol and morphine to reduce the manifestations of a systemic inflammatory response throughout cardiac surgery with cardiopulmonary bypass