Effects of anesthetic choice on inflammatory response in cardiac surgery

Elif Dogan Bakı, Remziye Gül Sıvacı, Serdar Kokulu, Yüksel Ela, Mustafa Aldemir


Cardiac surgery is associated with the development of a systemic inflammatory response. The cytokine response in patients undergoing cardiac surgery is well described and is dominated by the pro-inflammatory cytokines tumour necrosis factor (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), and the antiinflammatory cytokine interleukin-10 (IL-10). The release of these cytokines has been associated with the development of complications after cardiopulmonary bypass (CPB). In addition to many factors, choice of anesthetic agents affects immune response in cardiac surgery. This article summarizes recently published literature concerning inflammatory cytokines associated with cardiopulmonary bypass, use of anesthetic management techniques and their effects on inflammatory response in cardiac surgery.

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Baki ED, Aldemir M, Kokulu S, Koca HB, Ela Y, Sıvacı RG, et al. Comparison of the effects of desflurane and propofol anesthesia on the inflammatory response and S100β protein during coronary artery bypass grafting. Inflammation 2013; 36:1327-1333.


Laffey JG, Boylan JF, Cheng JH. The systemic inflammatory response to cardiac surgery, implications for the anesthesiologist. Anesthesiology 2002; 97:215-252.


Kapoor MC, Ramachandran TR. Inflammatory response to cardiac surgery and strategies to overcome it. Annals of Cardiac Anaesthesia 2004; 7:113-128.

Asimakopoulos G, Gourlay T. A review of antiinflammatory strategies in cardiac surgery. Perfusion 2003; 18:7-12.


Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75:715-720.


Galley HF, Dubbels AM, Webster NR. The effect of midazolam and propofol on interleukine-8 from human polmorphonuclear leukocyte. Anesth Analg 1998:1289-1293.

Salo M, Pirttikansgas CO, Pulkki K. Effect of propofol emulsion and thiopentone on T hepler cell type -1/type- 2 balance in vitro. Anaesthesia 1997; 52:341-344.


Butterworth JF, Mackey DC, Wasnick JD. Anesthesia for cardiovascular surgery. Morgan& Michail's Clinical Anesthesiology. 5th edition. United States. 2013; 435-486.

El-Azab SR, Rossel PMJ, De Lange JJ, van Wijk EM, van Strik R, Scheffer GJ. Effect of VIMA with sevoflurane versus TIVA with propofol or midazolam-sufentanil on the cytokine response during CABG surgery. Eur J Anaesthesiol 2002; 19:276-282.


Welters D, Feurer MK, Preiss V, Muller M, Scholz S, Kwapisz M, et al. Continuous S-(+)-ketamine administration during elective coronary artery bypass graft surgery attenuates proinflammatory cytokine response during and after cardiopulmonary bypass. Br J Anaesth 2011; 106: 172-179.


Jansen NJ, van Oeveren W, van den Broek L, Oudemans-van Straaten HM, Stoutenbeek CP, Joen MC, et al. Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 102:515-525.

Sun D, Xu C, Li J, Jiao X, Chen Y. Changes of inflammatory factors in patients with coronary artery disease during perioperation. Zhonghua Wai Ke Za Zhi 2002; 40:571-573.

Seghaye MC, Grabitz RG, Duchateau J, Busse S, Däbritz S, Koch D, et al. Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations. J Thorac Cardiovasc Surg 1996; 112:687-697.


Ozawa T, Yoshihara K, Koyama N, Watanabe Y, Shiono N, Takanashi Y. Clinical efficacy of heparin-bonded bypass circuits related to cytokine responses in children. Ann Thorac Surg 2000; 69:584-590.


Khabar KS, elBarbary MA, Khouqeer F, Devol E, al-Gain S, al-Halees Z. Circulating endotoxin and cytokines after cardiopulmonary bypass: differential correlation with duration of bypass and systemic inflammatory response/multiple organ dysfunction syndromes. Clin Immunol Immunopathol 1997; 85:97-103.


Fortenberry JD, Bhardwaj V, Niemer P, Cornish JD, Wright JA, Bland L. Neutrophil and cytokine activation with neonatal extracorporeal membrane oxygenation. J Pediatr 1996; 128:670-678.


Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell communication. J Cardiothorac Vasc Anest 1997; 11:367-375.


Hirai S, Sueda T, Orihashi K, Watari M, Okada K. Kinetics of pro-inflammatory cytokines release in cardiac surgery with cardiopulmonary bypass. Jpn J Thorac Cardiovasc Surg 2001; 49:216-219.


Gessler P, Pfenninger J, Pfammatter JP, Carrel T, Baenziger O, Dahinden C. Plasma levels of interleukin-8 and expression of interleukin-8 receptors on circulating neutrophils and monocytes after cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 2003; 126:718-725.


de Waal Malefyt R, Abrams J, Bennett B, Figdor CG, de Vries JE. Interleukin 10(IL-10) inhibits cytokine synthesis by human monocytes: an autoregulatory role of IL-10 produced by monocytes. J Exp Med 1991; 174:1209-1220.


Yang Z, Zingarelli B, Szabo C. Crucial role of endogenous interleukin-10 production in myocardial ischemia/reperfusion injury. Circulation 2000; 101:1019-1026.


Winterhalter M, Brandl K, Rahe-Meyer N, Osthaus A, Hecker H, Hagl C, et al. Endocrine stress response and inflammatory activation during CABG surgery. A randomized trial comparing remifentanil infusion to intermittent fentanyl. Eur J Anaesthesiol 2008; 25:326-335.


Lysle DT, Hoffman KE, Dykstra LA. Evidence for the involvement of the caudal region of the periaqueductal gray in a subset of morphine-induced alterations of immune status. J Pharmacol Exp Therap 1996; 277:1533-1540.

Makman MH, Bilfinger TV, Stefano GB. Human granulocytes contain an opiate alkaloid-selective receptor mediating inhibition of cytokine-induced activation and chemotaxis. J Immunol 1995; 154:1323-1330.

McBride WT, Armstrong MA, McMurray TJ. An investigation of the effects of heparin, low molecular weight heparin, protamine, and fentanyl on the balance of pro- and anti-inflammatory cytokines in in-vitro monocyte cultures. Anaesthesia 1996; 51:634-640.


Guggenberger H, Schroeder TH, Vonthein R, Dieterich HJ, Shernan SK, Eltzschig HK. Remifentanil or sufentanil for coronary surgery: comparison of postoperative respiratory impairment. Eur J Anaesthesiol 2006; 23: 832-840.


Brix-Christensen V, Tønnesen E, Sørensen IJ, Bilfinger TV, Sanchez RG, Stefano GB. Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute-phase protein responses in patients undergoing cardiac surgery. Acta Anaesthesiol Scand 1998; 42:63-70.


Christiansen CL, Ahlburg P, Jakobsen CJ, Andresen EB, Paulsen PK. The influence of propofol and midazolam/halothane anesthesia on hepatic SvO2 and gastric mucosal pH during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1998; 12:418-421.


Gilliland HE, Armstrong MA, Carabine U, McMurray TJ. The choice of anesthetic maintenance technique influences the antiinflammatory cytokine response to abdominal surgery. Anesth Analg 1997; 85:1394-1398.

Galley HF, Dubbels AM, Webster NR. The effect of midazolam and propofol on interleukin-8 from human polymorphonuclear leukocytes. Anesth Analg 1998; 86:1289-1293.

Mathy-Hartert M, Deby-Dupont G, Hans P, Deby C, Lamy M. Protective activity of propofol, diprivan and intralipid against active oxygen species. Mediators Inflamm 1998; 7:327-333.


Szekely A, Heindl B, Zahler S, Conzen PF, Becker BF. Nonuniform behavior of intravenous anesthetics on postischemic adhesion of neutrophils in the guinea pig heart. Anesth Analg 2000; 90:1293-1300.


Corcoran TB, Engel A, Sakamoto H, O'Shea A, O'Callaghan-Enright S, Shorten GD. The effects of propofol on neutrophil function, lipid peroxidation and inflammatory response during elective coronary artery bypass grafting in patients with impaired ventricular function. Br J Anaesth 2006; 97: 825-831.


Helmy SA, Wahby MA, El Nawaway M. The effect of anaesthesia and surgery on plasma cytokine production. Anaesthesia 1999; 54: 733-738.


Brookes ZL, Reilly CS, Lawton BK, Brown NJ. Intravenous anesthesia inhibits leukocyte-endothelial interactions and expression of CD11b after hemorrhage. Shock 2006; 25: 492-499.


Guarricino F, Landoni L. Tritapepe L, Pompei F, Leoni A, Aletti G, et al. Cardiac protection by volatile anaesthetics: A multicenter randomized controlled study. J Cardiothorac Vasc Anesth 2006; 20:477-483.


Xia Z, Huang Z, Ansley DM. Large-dose propofol during cardiopulmonary by pass decreases biochemical markers of myocardial injury in coronary surgery patients: A comparison with isoflurane. Anesthesia and Analgesia 2006; 103:527-532.


Mitsuhata H, Shimizu R, Yokoyama MM. Suppressive effects of volatile anesthetics on cytokine release in human peripheral blood mononuclear cells. Int J Immunopharmacol 1995; 17:529-534.


Kotani N, Hashimoto H, Sessler DI, Kikuchi A, Suzuki A, Takahashi S, et al. Intraoperative modulation of alveolar macrophage function during isoflurane and propofol anesthesia. Anesthesiology 1998; 89:1125-1132.


Louvier N, Lancon JP. Do halogenated anesthetics protect from ischemic and reperfusion myocardial injuries? Ann Fr Anesth Reanim 1994; 13:690-698.


Tanguay M, Blaise G, Dumont L, Beique G, Hollmann C. Beneficial effects of volatile anesthetics on decrease in coronary flow and myocardial contractility induced by oxygen-derived free radicals in isolated rabbit hearts. J Cardiovasc Pharmacol 1991; 18:863-870.


Roytblat L, Talmor D, Rachinsky M, Greemberg L, Pekar A, Appelbaum A, et al. Ketamine attenuates the interleukin-6 response after cardiopulmonary bypass. Anesth Analg 1998; 87:266-271.

Heller A, Heller S, Blecken S, Urbaschek R, Koch T. Effects of intravenous anesthetics on bacterial elimination in human blood in vitro. Acta Anaesthesiol Scand 1998; 42:518-526.


Roytblat L, Talmor D, Rachinsky M, Greemberg L, Pekar A, Appelbaum A, et al. Ketamine attenuates the interleukin-6 response after cardiopulmonary bypass. Anesth Analg 1998; 87: 266-271.

Bartoc C, Frumento RJ, Jalbout M, Bennett-Guerrero E, Du E, Nishanian E. A randomized, doubleblind, placebo-controlled study assessing the anti-inflammatory effects of ketamine in cardiac surgical patients. J Cardiothorac Vasc Anesth 2006; 20: 217-22


Beilin B, Rusabrov Y, Shapira Y, Roytblat L, Greemberg L, Yardeni IZ, et al. Low-dose ketamine affects immune responses in humans during the early postoperative period. Br J Anaesth 2007; 99: 522-527.


DOI: http://dx.doi.org/10.14800/ics.75


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