Effect of anesthetic factors on inflammatory responses in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass: sevoflurane-dexmedetomidine combined anesthesia / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the effect of sevoflurane-dexmedetomidine combined anesthesia on inflammatory responses in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods:A total of 96 American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 45-60 yr, weighing 60-75 kg, with New York Heart Association Ⅱ or Ⅲ, scheduled for elective CABG with CPB, were divided into 4 groups ( n=24 each) using a random number table method: routine general anesthesia (group C), sevoflurane-based general anesthesia group (group S), dexmedetomidine-based general anesthesia group (group D) and sevoflurane combined with dexmedetomidine-based general anesthesia group (group SD). In D and SD groups, dexmedetomidine was intravenously infused in a loading dose of 1μg/kg over 10 min at the beginning of induction anesthesia, followed by an infusion at 0.4 μg·kg -1·h -1 until the end of the surgery.After tracheal intubation, 1%-2% sevofluran was inhaled in S and SD group.Before anesthesia induction, before the CPB, immediately at the end of CPB, at 6 h after the end of CPB and 24 h after surgery, central venous blood samples were collected for determination of plasma interleukin-6 (IL-6), IL-10 and tumor necrosis factor-alpha (TNF-α) concentrations by enzyme linked immunosorbent assay.The restoration of spontaneous heart beat, the occurrence of serious adverse events during surgery and within 24 h after surgery, the retention time of intubation and duration of intensive care unit (ICU) stay after surgery were recorded. Results:Compared with group C, the plasma concentrations of IL-6, IL-10 and TNF-α were significantly decreased in the other 3 groups, and the postoperative retention time of tracheal intubation was shortened in group SD ( P<0.05). Compared with group S or group D, the plasma concentrations of IL-6, IL-10 and TNF-α were significantly decreased ( P<0.05), and no significant change was found in the postoperative retention time of tracheal intubation in group SD ( P>0.05). There was no significant difference in the duration of ICU and restoration of spontaneous heart beat ( P>0.05), and no serious adverse events occurred during surgery and within 24 h after surgery among the groups. Conclusion:Sevoflurane combined with dexmedetomidine anesthesia is helpful in reducing the inflammatory responses in patients undergoing CABG with CPB, but provides no value in clinical outcomes.