Affiliation:
1. Department of Intensive Care, Waikato Hospital, Hamilton, New Zealand
2. Department of Intensive Care and Consultant Anaesthetist, Department of Anaesthesia and Intensive Care, Whangarei Base Hospital, Whangarei.
3. Molecular Genetics Laboratory, University of Waikato.
Abstract
Vasodilation after coronary artery bypass surgery is a common complication. Inflammatory mediators influence the expression of alpha 1-adrenergic receptors. Do patients requiring high doses of postoperative inotropic support have down-regulated alpha-adrenergic receptors'? Is there a characteristic pattern of preoperative inflammatory mediator expression that could predict a complicated course after the operation? Forty-four patients undergoing cardiac bypass surgery with extracorporeal circulation were prospectively investigated. Five perioperative blood samples were taken (preoperative, two hours, 12 hours, 36 hours and 72 hours postoperative). The leucocyte mRNA-expression of the three alpha 1-adrenergic receptor subtypes (A, B and D) and 11 different pro-inflammatory mediators were investigated with the real-time reverse transcriptase polymerase chain reaction. The patients were divided into three groups (No-noradrenaline [No-NA]=0 μg/min, Low-noradrenaline [Low-NA]=0.1-7 μg/min, High-noradrenaline [High-NA] >7 ixglmin), according to their postoperative noradrenaline requirements. Preoperatively, alpha 1A-receptor expression was 4.9-fold (High-NA) and 18.7-fold (Low-NA) higher than the No-NA group (P=0.005) and plasma noradrenaline levels were higher in the High-NA group (P=0.005). Across all groups at 12 hours after the operation, alpha 1A-receptor expression decreased to approximately one-fifth of preoperative levels (P=0.01); but with greater duration and magnitude of relative decrease in the High-NA group. Patients in the No-NA group had significant postoperative increases in leucocyte inflammatory mediator expression for IL-1β, TLR4, TREM, MPO, MMP9 and TNF genes, whereas the changes in the Low-NA and High-NA groups were not significant. Low preoperative levels of noradrenaline and low expression of alpha 1A-adrenoreceptors in leucocytes was associated with less probability of requiring noradrenaline support after cardiac surgery.
Subject
Anesthesiology and Pain Medicine,Critical Care and Intensive Care Medicine
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献