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F₂-ISOPROSTANE FORMATION IN HIGH RISK PATIENTS DURING ACBP SURGERY

Departments of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia

INTRODUCTION

8-iso-Prostaglandin F₂ (8-iso-PGF₂), a marker of oxidant stress, may be a mediator of myocardial depression.^1,2 We wanted to characterize the perioperative generation of 8-iso-PGF₂ during ACBP surgery in two high risk patient groups, sp. patients with a preoperative history of diabetes mellitis (DM) or congestive heart failure (CHF).

METHODS

A pilot study of 30 patients scheduled for ACBP surgery was conducted. Anesthesia care was standardized to fentanyl 10-15 µg•kg / Isoflurane 0.05-2.0% in air/O₂. Hemodynamic monitoring included arterial and pulmonary artery catheterization. Central venous blood sampling was conducted at baseline, 30 min global ischemia, 10, 30, and 120 min reperfusion. Plasma 8-iso-PGF₂ levels were determined by radioimmunoassay ( Caymen Chemical, Ann Arbor, MI). p<0.05 was considered significant.

RESULTS

Eight patients had a preoperative history of DM ( Type I or II ), 7 patients had CHF. 8-iso-PGF₂ increased significantly during ischemia in diabetic vs nondiabetic controls (n = 15)(288 ± 135 vs 176 ± 48 pg/ml; p=0.03). In contrast, 8-iso-PGF₂ increased significantly at 10-30 min reperfusion, in patients with a pre-operative history of CHF ( 183 ± 72 vs 100 ± 36 pg/ml; p=0.01). This elevation in 8-iso-PGF₂ persisted up to 120 min reperfusion. Mean 8-iso-PGF₂ remained elevated above baseline(141.8 ± 48 pg/ml vs 69.5 ± 12 pg/ml), in patients requiring two or more inotropes for postoperative hemodynamic stabilization ( n=6; p=0.03 ). 8-iso-PGF₂ returned to baseline by 30 min reperfusion in patients not requiring inotropic support ( n =5 ). No patient in this group had a preoperative history of DM or CHF.

DISCUSSION

Oxidant stress during ACBP surgery may contribute to postoperative myocardial depression. A preoperative history of DM or CHF may predict the increased production of a biologically active marker of oxidant stress, 8-iso-PGF₂. The timing and duration of increased 8-iso-PGF₂ generation, may indicate differences in the pathogenesis of postoperative myocardial depression in patients with DM and CHF. Further study, including the effect of antioxidant strategies for ACBP surgery in patients with DM or CHF, is required.

REFERENCES

1 Circulation 1997; 95: 2492–9.[Abstract/Free Full Text]

2 Circulation 1998; 97: 1536–9.[Abstract/Free Full Text]

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