Influence of low-opioid anesthesia in cardiac surgery on dynamics of pro-inflammatory interleukin-6

Abstract

Introduction With coronary artery bypass grafting, patients are subjected to additional risk caused by both surgical treatment itself and pathophysiological changes in homeostasis, provoked by the action of anesthetics and cardiopulmonary bypass. Material and methods The study involved 60 patients, who had been subjected to coronary artery bypass grafting with cardiopulmonary bypass. All patients were divided into two groups: group I (30 patients) – low-opioid scheme of anesthesia and group II (30 patients) – standard scheme of anesthetic management. Blood interleukin-6 (IL-6) was identified before and after cardiopulmonary bypass using an ELISA test. Results Having compared IL-6 values between study groups after completion of cardiopulmonary bypass, it was established that IL-6 levels were 27.51% ( p = 0.001) lower in patients of group I compared with the results of patients in group II. Patients in the first group had a significantly shorter time of mechanical ventilation compared to group II (2.1 ±0.7 hours vs. 3.9 ±0.9 hours, p = 0.021). Low cardiac output syndrome was significantly less frequently reported in patients of group I (10.0% vs. 33.3%, p = 0.028). In addition, patients in group I had a significantly shorter time of intensive care unit (ICU) stay (2.5 ±0.7 days vs. 3.5 ±1.0 days, p = 0.044). Conclusions Application of multimodal low-opioid anesthesia was associated with significantly lower IL-6 at the end of surgery, shorter mechanical ventilation duration, less frequent low cardiac output syndrome and need for catecholamines, and shorter ICU stays.

Analysis of early cardiac complications after coronary artery bypass grafting under two different regimens of anesthesia

“…Due to the importance of IL-6 levels in the development of early cardiac complications, a possible mechanism for reducing their frequency in low-opioid anesthesia is a reduction of the inflammatory response, which could be achieved by direct opioid dose reduction and the addition of lidocaine, ketamine or dexmedetomidine. This hypothesis is confirmed by our previous study, in which low-opioid anesthesia was characterized by significantly lower levels of IL-6 after CPB compared to standard doses of opioids [10].…”

A comparison of opioid-containing anesthesia versus opioid-free anesthesia using the Cortínez-Sepúlveda model on differential cytokine responses in obese patients undergoing gastric bypass surgery: a randomized controlled trial

“…Previous studies have shown the clinical relevance of the IL-6 and other interleukins, since they can be useful as predictive factors that can identify patients at risk for postoperative complications [30]. Furthermore, Il-6 has been described as a good predictor of morbidity and mortality [31], cardiac complications and shorter duration of mechanical ventilation [32].…”

A comparison of opioid-containing anesthesia versus opioid-free anesthesia using the Cortínez-Sepúlveda model on differential cytokine responses in patients undergoing gastric bypass surgery: a randomized controlled trial

“…In this regard, serum levels of this cytokine have shown a positive correlation with the time of surgery (r = 0.554, p < 0.01) and the amount of blood lost during surgery (r = 0.427, p < 0.01) since IL-6 is an important mediator in response to trauma [16]. Previous studies have shown that IL-6 and other interleukins can be useful as predictive factors that can identify patients at risk for postoperative complications [30], since it has been described as a good predictor of further morbidity and mortality [31], cardiac complications and shorter duration of mechanical ventilation [32].…”