ABSTRACT
OBJECTIVE: To determine whether the antioxidant and anti-inflammatory properties of propofol confer benefit in adult patients undergoing elective coronary artery bypass grafting. DESIGN: Prospective, blinded, randomized, controlled clinical investigation. SETTING: Single-center, university teaching hospital and academic research laboratory. PARTICIPANTS: Twenty-one adult patients (11 control, 10 intervention) with chronic stable angina and normal ventricular function scheduled to undergo elective coronary artery bypass grafting. INTERVENTIONS: All patients received a standardized fentanyl-isoflurane anesthetic. Fifteen minutes before reperfusion, patients in the intervention group received a target-controlled infusion of propofol, continued for 4 hours after cross-clamp release. Patients in the control group received saline administered in a similar fashion. MEASUREMENTS: Serum concentration of malondialdehyde (MDA) (from systemic and coronary sinus blood); systemic concentrations of interleukins 4, 6, 8, and 10; and systemic leukocyte functions (respiratory burst, phagocytosis, and beta(2) integrin expression) were measured up to 36 hours after reperfusion. RESULTS: A high serum malondialdehyde concentration was detected in the coronary sinus in control patients, 10 minutes after reperfusion; serum malondialdehyde was not detected in the coronary sinus at this time in patients who received propofol (41.4 [15.6-1,150] micromol/L v 0, p = 0.004). Interleukin-8 concentrations increased 2 and 4 hours after reperfusion in the control group. Interleukin-6 concentrations were greater in the control group than the propofol group 4 hours after clamp release (289.1 [165.2-561] rhog/mL v 153.2 (58.2-280.3) rhog/mL, respectively, p = 0.003). Mean dose of propofol was 31.7 mg/kg during the study period. CONCLUSION: Clinically relevant concentrations of propofol may attenuate free radical-mediated and inflammatory components of myocardial reperfusion injury in patients undergoing elective coronary artery bypass graft surgery.
