BJA Advance Access originally published online on July 31, 2009
British Journal of Anaesthesia 2009 103(4):511-517; doi:10.1093/bja/aep201
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Profound haemodilution during normothermic cardiopulmonary bypass influences neither gastrointestinal permeability nor cytokine release in coronary artery bypass graft surgery
1 Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany.
2 Department of Gastroenterology and Hepatology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Germany.
3 SOSTANA (Sophisticated Statistical Analysis) GmbH and Charité-Universitätsmedizin Berlin, Germany
* Corresponding author. E-mail: christian.von_heymann{at}charite.de
Background: Cardiopulmonary bypass (CPB) impairs intestinal barrier function and induces systemic inflammation after cardiac surgery. The objective of this study was to evaluate the effect of profound haemodilution (haematocrit 19–21%) during normothermic CPB on gastrointestinal permeability and cytokine release in comparison with a standard haemodilution (haematocrit 24–26%).
Methods: This was a prospective, controlled, randomized pilot trial of 60 patients without gastrointestinal disease undergoing normothermic CPB (35.5–36°C) for coronary artery bypass graft surgery. Gastrointestinal permeability was measured by the triple-sugar technique (sucrose, lactulose, and mannitol excretion in urine) before and after CPB. Interleukin (IL)-6, IL-10, and tumour necrosis factor alpha (TNF
) were quantified using enzyme-linked immunosorbent assays.
Results: Data from 59 patients (19–21% haematocrit, n=28; 24–26% haematocrit, n=31) were analysed. Data on gastrointestinal permeability were available for 47 patients (19–21% haematocrit, n=23; 24–26% haematocrit, n=24), blood samples for cytokine analysis from 59 patients. Mannitol excretion was normal before and after surgery without significant differences between the groups (after operation: 5.4% vs 2.9%, P=0.193). Lactulose and sucrose excretion was within a normal range before surgery and increased afterwards without differences between the groups. IL-6, IL-10, and TNF were elevated after surgery, but there was no difference between the groups [IL-6 (P=0.78), IL-10 (P=0.74), and TNF (P=0.67)].
Conclusions: Profound haemodilution during normothermic CPB brought about significant changes neither in intestinal permeability nor in cytokine release. It may be concluded that a haematocrit of 19–21% during normothermic CPB does not impair intestinal barrier function and cytokine response in patients without gastrointestinal comorbidity.
Keywords: anaesthesia, general; gastrointestinal tract, mucosal perfusion; heart, cardiopulmonary bypass; surgery, thoracic; transfusion