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CARDIOVASCULAR ANESTHESIA

Endothelial Ca²⁺ Signal Transduction Is Altered by Postoperative Serum from Patients Undergoing Coronary Surgery with Cardiopulmonary Bypass

Department of Anesthesiology and Intensive Care Medicine, Charitè-Universitätsmedizin Berlin, Berlin, Germany

Address correspondence to Thomas Volk, MD, Klinik für Anästhesiologie und Operative Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Mitte. Schumannstr. 20/21, 10117 Berlin, Germany. Address e-mail to thomas.volk{at}charite.de.

Endothelial dysfunction after surgery may be caused by alterations in the intracellular signaling properties of endothelial cells. Functional alterations are believed to be systemic and dependent on the amount of invasiveness. This led us to assume that there would be a mediator in the blood. Therefore, we investigated the influence of perioperative serum obtained from patients undergoing highly invasive surgical interventions (cardiac surgery [CS] with cardiopulmonary bypass) and less invasiveness (total joint arthroplasty [TJA]) on endothelial single cell Ca²⁺ responses. Aortic endothelial cells were incubated with preoperative and postoperative serum samples from 26 patients undergoing CS and from 15 patients undergoing TJA. Adenosine triphosphate (100 µM)-induced alterations in FURA-2 fluorescence was used to measure intracellular Ca²⁺ in single cells. In CS samples the induced [Ca²⁺]_i signals were enhanced by postoperative serum (peak levels: 96 ± 41 FU versus 116 ± 45 FU; P < 0.05). These postoperative enhancements were absent in TJA patients serum. Preincubation of CS samples with nifedipine to block voltage gated Ca²⁺ channels did not alter this effect, but the absence of extracellular Ca²⁺ abolished the increased response from postoperative CS serum exposure. Ca²⁺ entry probed with Mn²⁺ quenching was increased in endothelial cells exposed with postoperative CS serum and Ca²⁺ entry correlated with postoperative circulating interleukin-6 levels (P < 0.007). Endothelial functional alterations after CS with cardiopulmonary bypass are attributable, in part, to systemic factors present in serum that lead to specific endothelial enhanced Ca²⁺-signaling. This enhancement can be separated in vitro as an increased Ca²⁺ entry not present in serum from patients recovering from TJA.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999