Use of inflammatory cytokines and blood PAPP-A levels as the laboratory evidence of preconditioning in cardiac surgery; [Kardiyak cerrahide önkoşullamanın laboratuvar kanıtları olarak olarak inflamatuvar sitokinlerin ve kan PAPP-A düzeylerinin kullanımı]

Cardioprotective management has increasingly become a standard of care for preservation of myocardial reserve during cardiac surgery. This study investigates the usefulness of inflammatory cytokines and PAPP-A levels in predicting the appropriate preconditioning method. Ninety ASA III patients scheduled for CABG surgery were included and allocated into three groups. Group 1 (n=30) received propofol (2-3 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 2 (n=30) received propofol (5-6 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 3 (n=30) received midazolam (0.04-0.06 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. TNF-α, PAPP-A and us-CRP levels were measured one day preo-peratively (S1), immediately prior to the cardiopulmonary bypass (S2), after completion of the cardiopulmonary bypass (S3) and 48 hours postoperatively (S4). In all groups, TNF-α increased at S2 and S3 and decreased at S4 (P<0.05), with the most prominent increase observed in Group 2. The highest increase in PAPP-A levels at S2 and S3 stages was observed in Group 2 whereas the lowest decrease at S4 stage was observed in Groups 1 and 3. In Group 1, us-CRP levels showed a significant increase at S3 compared to S1 and S2 (p<0.05) and decreased to levels close to S1 and S2. PAPP-A can be used with us-CRP and TNF-α to determine the optimal preconditioning method in the anaesthetic management of CABG surgery. Using these markers, we observed that midazolam-desflurane and low-dose propofol-desflurane were effective in anaesthetic preconditioning during CABG surgery. © 2017, Logos Medical Publishing. All rights reserved.