Title: Effect of sevoflurane on plasma levels of endothelin-1 and nitric oxide and pulmonary function in patients undergoing cardiac valve replacement with cardiopulmonary bypass
Abstract: Objective
To evaluate the effect of sevoflurane inhalation in the early stage of ischemia and reperfusion on pulmonary function and plasma levels of endothelin-1 (ET-1) and nitric oxide (NO) in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).
Methods
Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into two groups (n=20 each): control group (group C) and sevoflurane group (group S). All patients were treated with total intravenous anesthesia. In group S, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and before and after the ascending aorta was opened. Sevoflurane inhalation was not given in group C. The time points used were after anesthesia and before skin incision (T0), immediately before CPB (T1), immediately after CPB (T2), 2 h after CPB (T3), 6 h after CPB (T4), and 24 h after CPB (T5). At T0, T2, T3, and T5, radial artery blood was obtained to detect plasma levels of ET-1 and NO. At T1 and T2, pulmonary artery and pulmonary vein blood was obtained to detect neutrophil count and SP-A to calculate the difference between the vein and artery. At T0, T2, T3, T4, and T5, arterial blood gas was measured to calculate P(A-a)O2, OI, and Cst.
Results
Plasma levels of ET-1 (pg/mL) were significantly higher at T2 (6.6±1.8), T3 (5.9±1.4), and T5 (4.3±1.2) than at T0 (2.2±1.5) in group S (P<0.05), and at T2 (7.9±0.7), T3 (7.1±1.3), and T5 (5.8±0.9) than at T0 (2.3±1.1) in group C (P<0.05); compared with group C, e plasma ET-1 levels were significantly decreased in group S at T2, T3, and T5 (P<0.05). Plasma levels of NO (nmol/mL) were significantly higher at T2 (8.6±1.8), T3 (8.2±1.4), and T5 (6.9±1.7) than at T0 (5.9±1.2) in group S (P<0.05), and at T2 (7.3±1.1), T3 (7.0±1.1), and T5 (6.1±1.4) than at T0 (5.1±0.8) in group C (P<0.05); compared with group C, plasma NO levels were significantly higher in group S at T2, T3, and T5 (P<0.05). The neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly higher at T2 than at T0 in both groups (P<0.05); compared with group C, the neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly decreased in group S at T2 (P<0.05). SP-A levels in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly higher at T2 than at T0 in both groups (P<0.05); compared with group C, SP-A levels in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly decreased in group S at T2 (P<0.05). P (A-a)O2 was significantly higher at T2, T3, T4, and T5 than at T0 in both groups (P<0.05). OI was significantly lower at T2, T3, T4, and T5 than at T0 in both groups (P<0.05). Cst was significantly decreased at T2, T3, and T4 than at T0 in both groups (P<0.05). Compared with group C, P(A-a)O2 was significantly decreased in group S at T2, T3, and T4 (P<0.05), and OI and Cst were significantly higher in group S at T2, T3, and T4 (P<0.05).
Conclusion
Pulmonary injury and ET-1/NO disorder may occur during cardiac valve replacement with CPB, which can be improved by sevoflurane inhalation in the early stage of ischemia and reperfusion.
Key words:
Sevoflurane; Endothelin-1; Nitric oxide; Cardiopulmonary bypass
Publication Year: 2017
Publication Date: 2017-09-15
Language: en
Type: article
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