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Cardiovascular surgery using extracorporeal circulation causes a systemic inflammatory response which often results in severe organ dysfunction and increased postoperative mortality. Advances in knowledge about the interactions of cytokines involved in the response to cardiopulmonary bypass (CPB) may improve the outcome of patients undergoing cardiac surgery. The purpose of our study was to investigate the fluctuations in cytokine production, during and after CPB. In 24 patients undergoing elective coronary artery bypass grafting, plasma levels of interleukins IL-2, IL-6, IL-10 and IL-12, soluble IL-2-receptor (sIL-2R), and transforming growth factor-beta (TGF-beta) were measured at eight time points before, during and after CPB, using a standardized enzyme-linked immunosorbant assay technique. There was a significant increase in plasma levels of IL-10, IL-6 and TGF-beta after weaning off CPB. The IL-2 plasma levels decreased after the onset of CPB until 24 h postoperatively (p < 0.05). Concentrations of sIL-2R decreased 20 min after the start of CPB until the end of the operation (p < 0.05). In the postoperative course, sIL-2R levels increased, with peak values 48 h after the end of the surgical procedure. The IL-12 levels decreased after weaning off CPB (p < 0.05) until 6 h postoperatively. The results of our study demonstrate an intraoperative-predominant immunosuppression, followed by an early postoperative immunological activation, combined with a distinct acute phase response.

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A survey was conducted among British, French and German anaesthetists to evaluate possible national differences in the peri-operative use of muscle relaxants and their reversal agents. The same non-depolarizing relaxants are used in all three countries, with the exception of d-tubocurarine, which is only available in Great Britain, and alcuronium which is mainly used in Germany. The French anaesthetists seem to use significantly less succinylcholine than their peers in Great Britain or Germany for both elective and emergency intubation. Monitoring of neuromuscular blockade still relies mainly on "clinical judgement'. Reversal of non-depolarizing muscle relaxants is performed routinely in Great Britain, while a substantial number of French anaesthetists avoid the use of a reversal. Dose regimes for neostigmine vary largely, with German anaesthetists administering the lowest, and British anaesthetists administering the highest doses. Side effects of reversal agents are reported by colleagues from all three countries in too high a percentage to justify uncritical administration of these drugs. In Germany there seems to be a noteworthy lack of recovery facilities.

No abstract