Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass

Millar, Ann; Armstrong, Lynne; Linden, Jan van der; Moat, Neil; Ekroth, Rolf; Westwick, John; Scallan, M.; Lincoln, Christopher

doi:10.1016/0003-4975(93)90740-9

Cited by 166 publications

(90 citation statements)

References 12 publications

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“…5,6 Among the strategies used to reduce the inflammatory reactions induced by CPB and its consequences are treatment with steroids, 7 aprotinin, 8,9 heparin-coated CPB circuits, 10 and hemofiltration. 11 The omission of CPB itself might be a more radical and effective way of counteracting the effects of these inflammatory reactions and oxidative stress. For example, the rate of postoperative morbidity is reduced in patients undergoing cardiac operations without CPB, 12 and inflammatory reactions in patients undergoing bypass graft operations were reduced when CPB was not used.…”

mentioning

confidence: 99%

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Song

Lee

et al. 2008

Circ J

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Background Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed. Methods and ResultsThe study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index. Conclusions Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored. (Circ J 2008; 72: 1966 -1974

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confidence: 99%

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Song

Lee

et al. 2008

Circ J

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“…[28][29][30][31][32][33] Heparin-coated CPB circuits and intraoperative ultrafiltration are already routine procedures in many pediatric cardiac centers. Although evidence in favor of these therapeutic means is continually growing, ultrafiltration cannot be used in the postoperative period when reperfusion injury processes are greatest, and concentrations of inflammatory mediators appear not to be decreased immediately after ultrafiltration.…”

Section: Circulation Journal Vol71 June 2007mentioning

confidence: 99%

Significance of Peritoneal Fluid Drainage in Management After Repair of Complex Heart Defects in Infancy Cytokine Dynamics In Vivo

Kurobe

Kitaichi

Shimahara

et al. 2007

Circ J

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“…CVVH has been employed to reduce the inflammatory response associated with cardiothoracic surgery [66]. Indeed, in patients undergoing postoperative renal replacement therapy, hemofiltration effluent has been shown to contain tumor necrosis factor-alpha, interleukin-6, C3a, and C5a complexes [66][67][68]. Intraoperative CVVH during cardio-pulmonary bypass (CPB) has been shown to remove low-molecular-weight molecules from the plasma, including inflammatory mediators like cytokines [66,67].…”

Section: Inflammation and Anti-inflammatory Strategiesmentioning

confidence: 99%

Postoperative atrial fibrillation

et al. 2000

Journal of Cardiothoracic and Vascular Anesthesia

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Postoperative atrial fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Pathophysiology of POAF is not fully disclosed, and several perioperative factors could be involved. Direct cardiac stimulation from perioperative use of catecholamines or increased sympathetic outflow from volume loss/anaemia/pain may play a role. Metabolic alterations, such as hypo-/hyperglycaemia and electrolyte disturbances, may also contribute to POAF. Moreover, inflammation, both systemic and local, may play a role in its pathogenesis. Strategies to prevent POAF aim at reducing its incidence and ameliorate global outcome of surgical patients. Nonpharmacological prophylaxis includes an adequate control of postoperative pain, the use of thoracic epidural analgesia, optimization of perioperative oxygen delivery, and, possibly, modulation of surgery-associated inflammatory response with immunonutrition and antioxidants. Perioperative potassium and magnesium depletion should be corrected. The impact of those interventions on patients outcome needs to be further investigated.

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Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass

Cited by 166 publications

References 12 publications

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Significance of Peritoneal Fluid Drainage in Management After Repair of Complex Heart Defects in Infancy Cytokine Dynamics In Vivo

Postoperative atrial fibrillation

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