The effects of aprotinin and steroids on generation of cytokines during coronary artery surgery

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dc.authoridErsoy, Mehmet/0000-0002-0724-2825
dc.authorwosidErsoy, Mehmet/ACN-2779-2022
dc.contributor.authorTürköz, A
dc.contributor.authorÇigli, A
dc.contributor.authorBut, K
dc.contributor.authorSezgin, N
dc.contributor.authorTürköz, R
dc.contributor.authorGülcan, Ö
dc.contributor.authorErsoy, MÖ
dc.date.accessioned2024-08-04T20:12:12Z
dc.date.available2024-08-04T20:12:12Z
dc.date.issued2001
dc.departmentİnönü Üniversitesien_US
dc.description.abstractObjectives: To compare the efficacy of aprotinin and methylprednisolone in reducing cardiopulmonary bypass (CPB)-induced cytokine release, to evaluate the effect of myocardial cytokine release on systemic cytokine levels, and to determine the influence of cytokine release on perioperative and postoperative hemodynamics. Design: Prospective, randomized clinical trial. Setting: University teaching hospital and clinics. Participants: Thirty patients undergoing elective coronary artery bypass graft surgery. Interventions: Patients were randomly allocated into groups treated with aprotinin (n = 10) or methylprednisolone (n = 10) or into an untreated control group (n = 10). Aprotinin-treated patients received aprotinin as a high-dose regimen (6 x 10(6) KIU), and methylprednisolone-treated patients received methylprednisolone (30 mg/kg intravenously) before CPB. Measurements and Main Results: Patients were analyzed for hemodynamic changes and alveolar-arterial PO2 difference (AaDO(2)) until the first postoperative day. Plasma levels of proinflammatory cytokines (tumor necrosis factor [TNF]a, interleukin [IL]-1 beta, IL-6, and IL-8) were measured in peripheral arterial blood immediately before the induction of anesthesia, 5 minutes before CPB, 3 minutes after the start of CPB, 2 minutes after the release of the aortic cross-clamp, 1 hour after CPB, 6 hours after CPB, and 24 hours after CPB; and in coronary sinus blood immediately before CPB and 2 minutes after the release of the aortic cross-clamp. The hemodynamic parameters did not differ among the groups throughout the study. After CPB, AaDO(2) significantly increased (p < 0.05) in all groups. A significant decrease in AaDO(2) was observed in aprotinin-treated patients at 24 hours after CPB compared with the other groups (p < 0.05). TNF-a level from peripheral arterial blood significantly increased in control patients 1 hour after CPB (p < 0.01) and did not significantly increase in methylprednisolone-treated patients throughout the study. In all groups, IL-6 levels increased after the release of the aortic cross-clamp and reached peak values 6 hours after CPB. At 6 hours after CPB, the increase in IL-6 levels in methyl prednisolone-treated patients was significantly less compared with levels measured in control patients and aprotinin-treated patients (p < 0.001). In control patients, IL-8 levels significantly increased 2 minutes after the release of the aortic cross-clamp (p < 0.05), and peak values were observed 1 hour after CPB (p < 0.01). IL-8 levels in control patients were significantly higher compared with patients treated with aprotinin and patients treated with methylprednisolone 1 hour after CPB (p < 0.05). Conclusion: This study showed that methylprednisolone suppresses TNF-, IL-6, and IL-8 release; however, aprotinin attenuates IL-8 release alone. Methylprednisolone does not produce any additional positive hemodynamic and pulmonary effects. An improved postoperative AaDO(2) was observed with the use of aprotinin. Copyright (C) 2001 by W.B. Saunders Company.en_US
dc.identifier.doi10.1053/jcan.2001.26539
dc.identifier.endpage610en_US
dc.identifier.issn1053-0770
dc.identifier.issn1532-8422
dc.identifier.issue5en_US
dc.identifier.pmid11688002en_US
dc.identifier.scopus2-s2.0-0034778665en_US
dc.identifier.scopusqualityQ2en_US
dc.identifier.startpage603en_US
dc.identifier.urihttps://doi.org/10.1053/jcan.2001.26539
dc.identifier.urihttps://hdl.handle.net/11616/93281
dc.identifier.volume15en_US
dc.identifier.wosWOS:000171652200014en_US
dc.identifier.wosqualityQ3en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherW B Saunders Co-Elsevier Incen_US
dc.relation.ispartofJournal of Cardiothoracic and Vascular Anesthesiaen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectaprotininen_US
dc.subjectmethylprednisoloneen_US
dc.subjectcardiopulmonary bypassen_US
dc.subjectcytokineen_US
dc.titleThe effects of aprotinin and steroids on generation of cytokines during coronary artery surgeryen_US
dc.typeArticleen_US

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