Use of Inflammatory Cytokines and Blood PAPP-A Levels As The Laboratory Evidence of Preconditioning in Cardiac Surgery

Preconditioning in Cardiac Surgery
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 usCRP levels were measured one day preoperatively (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 Group 1 and 3. In Group 1, usCRP 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 usCRP 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