Anti-inflammatory effects of perioperative intensive insulin therapy during cardiac surgery with cardiopulmonary bypass

Hasegawa, Akira; Iwasaka, Hideo; Hagiwara, Satoshi; Koga, Hironori; Hasegawa, Rie; Kudo, Kazuhiro; Kusaka, Junya; Noguchi, Takayuki

doi:10.1007/s00595-010-4458-y

Cited by 15 publications

(12 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is also implicated in non-inflammatory conditions, including cancer, by regulating tumorigenesis and contributing to metastasis (23). HMGB1 levels increase significantly and last for a few days following liver resection (24) or cardiac surgery (25). In the present study, although the increased level of HMGB1 was not significant following surgery compared with the pre-surgical levels in the control group, there was a significant …”

Section: Discussioncontrasting

confidence: 62%

Intraoperative intravenous lidocaine exerts a protective effect on cell-mediated immunity in patients undergoing radical hysterectomy

Wang

Yan

Liu

et al. 2015

Molecular Medicine Reports

View full text Add to dashboard Cite

Abstract. Surgical procedures cause a decrease in lymphocyte proliferation rate, an increase in apoptosis and shifts the balance of T-helper (Th)1/Th2 cells towards anti-cell-mediated immunity (CMI) Th2 dominance, which is relevant to the immunosuppressive effects of CMI, postoperative septic complications and the formation of tumor metastasis. Previous studies have revealed that lidocaine exhibits antibacterial actions; regulating inflammatory responses, reducing postoperative pain and affecting the duration spent in hospital. Thus, the present study hypothesized that lidocaine may exert a protective effect on the CMI of patients undergoing surgery for the removal of a primary tumor. A total of 30 adult female patients diagnosed with cervical cancer were recruited to the present study and were randomized into two groups. The lidocaine group received an intravenous bolus dose of 1.5 mg/kg lidocaine, followed by continuous infusion at 1.5 mg/kg/h until discharge from the operating room. The control group received the same volume of normal saline. A 10 ml sample of venous blood was drawn, and the lymphocytes were isolated using Ficoll-paque 1 day prior to surgery, at discharge from the operating room and 48 h post-surgery. The proliferation rate of the lymphocytes was assessed using a Cell Counting Kit-8 assay and was found to be higher in the lidocaine group. The early apoptosis of lymphocytes was attenuated following lidocaine treatment at 48 h post-surgery, as detected using flow cytometry with Annexin V-fluorescein isothiocyanate/propidium iodide staining. The level of interferon (IFN)-γ in the serum at 48 h was significantly decreased following surgery in the control group, compared with the pre-surgical values (3.782±0.282, vs. 4.089±0.339 pg/ml, respectively) and the ratio of IFN-γ to interleukin-4 was well preserved in the lidocaine group. In conclusion, the present study demonstrated that the intraoperative systemic administration of lidocaine exerted a protective effect on CMI in patients with cervical cancer undergoing radical hysterectomy. This may be beneficial in reducing the occurrence of postoperative septic complications and tumor metastasis formation.

show abstract

Section: Discussioncontrasting

confidence: 62%

Intraoperative intravenous lidocaine exerts a protective effect on cell-mediated immunity in patients undergoing radical hysterectomy

Wang

Yan

Liu

et al. 2015

Molecular Medicine Reports

View full text Add to dashboard Cite

show abstract

“…Similarly Gagnon et al 4 documented that continued ventilation during CPB correlated with an attenuated inflammatory and proteolytic process and better preserved pulmonary function. It was suggested that maintaining ventilation and pulmonary flow during CPB attenuated the inflammatory response 3,5,16. The continuation of pulmonary blood flow during CPB also led to reduction in serum IL-6 and -8 levels 10…”

Section: Discussionmentioning

confidence: 99%

Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topic

Durukan¹,

Gürbüz²,

Salman³

et al. 2013

CVJA

View full text Add to dashboard Cite

IntroductionCardiopulmonary bypass causes a series of inflammatory events that have adverse effects on the outcome. The release of cytokines, including interleukins, plays a key role in the pathophysiology of the process. Simultaneously, cessation of ventilation and pulmonary blood flow contribute to ischaemia–reperfusion injury in the lungs when reperfusion is maintained. Collapse of the lungs during cardiopulmonary bypass leads to postoperative atelectasis, which correlates with the amount of intrapulmonary shunt. Atelectasis also causes post-perfusion lung injury. In this study, we aimed to document the effects of continued low-frequency ventilation on the inflammatory response following cardiopulmonary bypass and on outcomes, particularly pulmonary function.MethodsFifty-nine patients subjected to elective coronary bypass surgery were prospectively randomised to two groups, continuous ventilation (5 ml/kg tidal volume, 5/min frequency, zero end-expiratory pressure) and no ventilation, during cardiopulmonary bypass. Serum interleukins 6, 8 and 10 (as inflammatory markers), and serum lactate (as a marker for pulmonary injury) levels were studied, and alveolar–arterial oxygen gradient measurements were made after the induction of anaesthesia, and immediately, one and six hours after the discontinuation of cardiopulmonary bypass.ResultsThere were 29 patients in the non-ventilated and 30 in the continuously ventilated groups. The pre-operative demographics and intra-operative characteristics of the patients were comparable. The serum levels of interleukin 6 (IL-6) increased with time, and levels were higher in the non-ventilated group only immediately after discontinuation of cardiopulmonary bypass. IL-8 levels significantly increased only in the non-ventilated group, but the levels did not differ between the groups. Serum levels of IL-10 and lactate also increased with time, and levels of both were higher in the non-ventilated group only immediately after the discontinuation of cardiopulmonary bypass. Alveolar–arterial oxygen gradient measurements were higher in the non-ventilated group, except for six hours after the discontinuation of cardiopulmonary bypass. The intubation time, length of stay in intensive care unit and hospital, postoperative adverse events and mortality rates were not different between the groups.ConclusionDespite higher cytokine and lactate levels and alveolar–arterial oxygen gradients in specific time periods, an attenuation in the inflammatory response following cardiopulmonary bypass due to low-frequency, low-tidal volume ventilation could not be documented. Clinical parameters concerning pulmonary and other major system functions and occurrence of postoperative adverse events were not affected by continuous ventilation.

show abstract

“…As the total number of macrophages present after 6 months of treatment did not differ between the subgroups, it can be suggested that the phenotype of the macrophages is more pro-inflammatory, the adipocytes themselves are more inflamed, or other immune cells have infiltrated the adipose tissue in participants who gained over 4% of body weight. Although various reports have suggested that insulin suppresses inflammatory processes (at least systemically) [6,7], more excessive weight gain after the start of insulin therapy may overrule any anti-inflammatory actions of insulin.…”

Section: Discussionmentioning

confidence: 99%

“…Studies that have examined the effects of (intensive) insulin therapy on immune function and inflammatory factors have shown that the levels of systemic proinflammatory cytokines decrease after administration of insulin [6,7].…”

Section: Introductionmentioning

confidence: 99%

Start of insulin therapy in patients with type 2 diabetes mellitus promotes the influx of macrophages into subcutaneous adipose tissue

et al. 2013

View full text Add to dashboard Cite

Aims/hypothesis Insulin therapy in patients with type 2 diabetes mellitus is accompanied by weight gain characterised by an increase in abdominal fat mass. The expansion of adipose tissue mass is generally paralleled by profound morphological and inflammatory changes. We hypothesised that the insulinassociated increase in fat mass would also result in changes in the morphology of human subcutaneous adipose tissue and in increased inflammation, especially when weight gain was excessive. Methods We investigated the effects of weight gain on adipocyte size, macrophage influx, and mRNA expression and protein levels of key inflammatory markers within the adipose tissue in patients with type 2 diabetes mellitus before and 6 months after starting insulin therapy.

show abstract

Anti-inflammatory effects of perioperative intensive insulin therapy during cardiac surgery with cardiopulmonary bypass

Cited by 15 publications

References 18 publications

Intraoperative intravenous lidocaine exerts a protective effect on cell-mediated immunity in patients undergoing radical hysterectomy

Intraoperative intravenous lidocaine exerts a protective effect on cell-mediated immunity in patients undergoing radical hysterectomy

Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topic

Start of insulin therapy in patients with type 2 diabetes mellitus promotes the influx of macrophages into subcutaneous adipose tissue

Contact Info

Product

Resources

About