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CARDIOVASCULAR ANESTHESIA

Cerebrovascular Cytokine Responses During Coronary Artery Bypass Surgery: Specific Production of Interleukin-8 and Its Attenuation by Hypothermic Cardiopulmonary Bypass

Koichiroh Nandate, MD^*,, Alain Vuylsteke, MD, Alan E. Crosbie, PhD, Souad Messahel, PhD^*, Amo Oduro-Dominah, MRCP, FRCA, and David K. Menon, MD, PhD^*

Departments of Anaesthesia, *University of Cambridge and Papworth Hospital, Cambridge, United Kingdom

Address correspondence and reprint requests to Dr. David K. Menon, University Department of Anaesthesia, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK.

Brain dysfunction after cardiopulmonary bypass (CPB) is common, and it has been hypothesized that this injury might be due partly to activation of inflammatory processes in the brain. We measured juguloarterial gradients for interleukin-1ß, interleukin-6, and interleukin-8 (IL-8) as indices of local proinflammatory cytokine production in the brain and studied the effect of temperature during CPB on these changes. Twelve patients undergoing coronary artery bypass graft surgery (normothermic CPB n = 6, hypothermic CPB n = 6) were studied. Cytokine levels were measured in paired arterial and jugular bulb samples obtained before, during, and after CPB. Although systemic levels of all three cytokines increased during and after CPB, increases in juguloarterial cytokine gradients were observed only for IL-8. Juguloarterial IL-8 gradients started to increase 1 h post-CPB and were significantly elevated 6 h post-CPB (P < 0.05). At this time point, the median (interquartile range) juguloarterial IL-8 gradients were significantly larger in the normothermic CPB group (25.81 [24.49–39.51] pg/mL) compared with the hypothermic CPB group (6.69 [-0.04 to 15.47] pg/mL; P < 0.05). These data imply specific and significant IL-8 production in the cerebrovascular bed during CPB and suggest that these changes may be suppressed by hypothermia during CPB.

Implications: Using juguloarterial gradients to measure cerebrovascular cytokine production is novel in the setting of cardiopulmonary bypass and implicates the cerebral activation of inflammatory processes, which may contribute to brain dysfunction. Hypothermia during cardiopulmonary bypass may significantly attenuate this response.

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