Journal Article

Cardiospecific sevoflurane treatment quenches inflammation but does not attenuate myocardial cell damage markers: a proof-of-concept study in patients undergoing mitral valve repair

K. A. Kortekaas, A. van der Baan, L. P. H. J. Aarts, M. Palmen, C. M. Cobbaert, J. C. M. Verhagen, F. H. M. Engbers, R. J. M. Klautz and J. H. N. Lindeman

Edited by J. P. Thompson

in BJA: British Journal of Anaesthesia

Published on behalf of the British Journal of Anaesthesia

Volume 112, issue 6, pages 1005-1014
Published in print June 2014 | ISSN: 0007-0912
Published online March 2014 | e-ISSN: 1471-6771 | DOI: http://dx.doi.org/10.1093/bja/aet588
Cardiospecific sevoflurane treatment quenches inflammation but does not attenuate myocardial cell damage markers: a proof-of-concept study in patients undergoing mitral valve repair

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Background

Inflammation is considered a key mediator of complications after cardiac surgery. Sevoflurane has been shown to quench inflammation and to provide cardioprotection in preclinical studies. Clinical studies using sevoflurane confirm this effect on inflammation but do not consistently show clinical benefits. This paradox may indicate that the contribution of inflammation to postoperative sequalae is less than commonly thought or that systemic doses are too low in their local concentration. To test the latter, we evaluated the effects of intramyocardial sevoflurane delivery.

Methods

Selective myocardial sevoflurane delivery was performed during aortic cross-clamping in patients undergoing valve surgery (n=11). Results were compared with a control group not receiving sevoflurane (n=10). A reference group (n=5) was added to evaluate the effects of systemic sevoflurane delivery. Paired arterial and myocardial venous blood samples were collected at various time points post-reperfusion. Inflammatory mediators and myocardial cell damage were studied.

Results

Intramyocardial delivery was superior to systemic delivery in attenuation of interleukin-6 and interleukin-8 (−44% and −25%, respectively; both P=0.001). Myocardial and systemic sevoflurane delivery effectively suppressed surgery-related inflammatory responses including postoperative C-reactive protein levels when compared with controls [63 (47–99) (P=0.01) and 58 (56–81) (P=0.04) compared with 107 (79–144) mg litre−1]. Sevoflurane treatment did not reduce postoperative troponin T, creatine kinase, and creatine kinase-MB values.

Conclusions

This proof-of-concept study suggests that intramyocardial delivery compared with the systemic delivery of sevoflurane more strongly attenuates the systemic inflammatory response after cardiopulmonary bypass without reducing postoperative markers of myocardial cell damage.

Clinical trial registration

Nederlands Trial Register NTR2089.

Keywords: anaesthetics volatile, sevoflurane; cardiopulmonary bypass; immune response; myocardial damage; reperfusion injury

Journal Article.  4723 words.  Illustrated.

Subjects: Anaesthetics

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