Journal
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
Volume 11, Issue 6, Pages 758-762Publisher
OXFORD UNIV PRESS
DOI: 10.1510/icvts.2010.243600
Keywords
Myocardial protection; Ischaemic preconditioning; Troponin I; Inducible nitric oxide synthases; Endothelial nitric oxide synthases
Funding
- Internal Grant Agency, Ministry of Health [NR/9194-3]
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The purpose of this study was to test, whether the late phase of remote ischaemic preconditioning (L-RIPC) improves myocardial protection in coronary artery bypass grafting (CABG) with cold-crystalloid cardioplegia and whether preoperative tramadol modifies myocardial ischaemia-reperfusion injury using the same group of patients in a single-blinded randomized controlled study. One hundred and one adult patients were randomly assigned to either the L-RIPC, control or tramadol group. L-RIPC consisted of three five-minute cycles of upper limb ischaemia and three five-minute pauses using blood pressure cuff inflation 18 hours prior to the operation. Patients in the tramadol group received 200 mg tramadol retard at 19: 00 hours, the day before the operation and at 06: 00 hours. Serum troponin I levels were measured at eight, 16 and 24 hours after surgery. Myocardial samples for inducible and endothelial nitric oxide synthases (iNOS, eNOS) estimation were drawn twice: before and after cannulation for cardiopulmonary bypass from the auricle of the right atrium. We found that L-RIPC can reduce injury beyond the myocardial protection provided by cold-crystalloid cardioplegia, and tramadol worsened myocardial injury after CABG. Expressions of iNOS were increased in the control (significantly) and L-RIPC groups and dampened in the tramadol group. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
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