ABSTRACT
Objective To evaluation the efficacy of ketamine on the expression of adhension molecular CR3and intracellular cAMP, cGMP in neutrephils in patients associated with cardiopulmonary bypass (CPB), as well as the cardiovascular function of the CPB patients. Method Sixty patients operated on with prosthetic valve replace-rnent under CPB were randomly divided into 4 groups: placebo, ketamine 0.1 mg/kg ( ketamine Ⅰ) ,ketamine 0.5 mg/kg ( ketamine Ⅱ) ,ketamine 1 mg/kg( ketamine Ⅲ). Each group included 15 eases. Venous blood sam-pies were obtained during anesthesia induction (T1), 10 min before CPB (T2), end of CPB (T3) and 24 hoursafter operation (T4). The expression of CR3 was measured by Flow cytometry and the concentration of cAMP/cGMP by HPLC. Results Ketamine with various dosages decreased the expression of CR3 at the T3 and T4 inpatients of ketamine groups compared with patients of placebo group (P<0.05). The dosages of ketamine Ⅱgroup and ketamine Ⅲ group had more significant effect than that of ketamine Ⅰ group. The dosages of ketamineⅡ and ketamine Ⅲ group increased the intracellular cAMP at the T3 and T4 compared with ketamine Ⅰ groupand placebo (p<0.05), respectively. However,cGMP was lower in ketamine Ⅱ and ketamine Ⅲ group thanthat in ketamine Ⅰ group and placebo (P<0.05) at the T3.Morever,the mean arterial blood pressure was higherin ketamine Ⅱ and ketamine Ⅲ group at T4. Only the patients of ketamine Ⅲ group required less inotropic drugsafter operation. Conclusions Ketamine can reduce the expression of adhhension molecular CB3 and intracellularcAMP, cGMP in neutrophils from patients associated with CPB.
ABSTRACT
Objective To investigate the influence of lidocaine on systemic inflammatory response to cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG) .Methods Twenty ASA Ⅱ or Ⅲ patients of both sexes (13 males, 7 females) aged 47-67 yrs weighing 62-82 kg undergoing CABG were randomly divided into 2 groups of 10 each: control group (C) and lidocaine group (L). In group L lidocaine infusion was started as soon as the pericardium was cut open and maintained at 4 mg?min-1 until the end of the surgery. Another dose of lidocaine (4 mg?kg-1) was added to the prime. In control group normal saline (NS) was given instead of lidocaine in the same volume and at the same speed. Blood samples were taken from radial artery before CPB (T0, baseline) and at 1, 10 and 60 min after release of the aortic cross-clamp (T1,2,3) for determination of plasma concentration of TNF-?, IL-6, IL-10 and PMN count. Plasma lidocaine concentration was determined at 10 and 60 min after initiation of CPB and at the end of surgery in 5 patients in group L. Results The two groups were comparable with respect to age, sex ratio (M/F), body weight, CPB time and aortic cross-clamping time. The mean plasma lidocaine concentration was (4.1?0.5)?g?ml-1, (4.6?0.7) ?g?ml-1 and (5.9?0.9)?g?ml-1 at 10, 60 min of CPB and end of surgery respectively in group L. Plasma concentrations of TNF-?, IL-6, IL-10 and PMN count were significantly increased at T1,2,3 as compared to the baseline values at T0 in both groups. The plasma concentrations of TNF-? and IL-6 were significantly lower while those of IL-10 were significantly higher at T1-3 in group L than in group C. Conclusion Lidocaine can inhibit the inflammatory response induced by CPB in patients undergoing CABG.