Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass

Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72) were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA) group of 11 patients (4 females and 7 males). The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumor necrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA (two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001), but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.

Avaliação de diferentes híbridos suínos submetidos à insensibilização elétrica e gasosa (CO2). Parte 1: mensuração de indicadores sanguíneos de estresse

Suínos provenientes de três linhagens genéticas A, B e C comercializadas no Brasil, com peso vivo de 100 a 120 kg foram submetidos ao insensibilizador elétrico manual (Karl Schermer 220-230/250 volts, 45-60 Hz e 1,4 -1,5 A) e ao sistema gasoso coletivo (COMBI-BUTINA 90% CO2). Alíquotas sanguíneas, para determinação dos níveis de creatina fosfoquinase (CPK), lactato e cortisol, assim como amostras do músculo semimembranosus (10 g) para a determinação do gene halotano, foram coletadas. Comparando-se os sistemas de insensibilização elétrico e gasoso (CO2), o elétrico demonstrou ser mais estressante, proporcionando maiores concentrações plasmáticas de cortisol (p < 0,001) e lactato (p < 0,001) para as linhagens genéticas A e C, nas condições estudadas, porém não se observou diferenças significativas para os indicadores sanguíneos e sistemas de insensibilização em questão quando a linhagem B foi considerada. Diferenças significativas entre as linhagens genéticas A, B e C foram obtidas comparando-se os valores plasmáticos de creatina fosfoquinase (p < 0,001), lactato (p < 0,001) e cortisol (p < 0,001) quando atordoados com o sistema gasoso, entretanto, quando o sistema elétrico foi utilizado, somente os valores de cortisol apresentaram diferenças significativas (p < 0,001). A presença do gene halotano (Nn) foi observada somente na linhagem B.