Inflammatory Response in Patients under Coronary Artery Bypass Grafting Surgery and Clinical Implications: A Review of the Relevance of Dexmedetomidine Use
Despite the fact that coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) prolongs life and reduces symptoms in patients with severe coronary artery diseases, these benefits are accompanied by increased risks. Morbidity associated with cardiopulmonary bypass can be attributed to the generalized inflammatory response induced by blood-xenosurfaces interactions during extracorporeal circulation and the ischemia/reperfusion implications, including exacerbated inflammatory response resembling the systemic inflammatory response syndrome (SIRS). The use of specific anesthetic agents with anti-inflammatory activity can modulate the deleterious inflammatory response. Consequently, anti-inflammatory anesthetics may accelerate postoperative recovery and better outcomes than classical anesthetics. It is known that the stress response to surgery can be attenuated by sympatholytic effects caused by activation of central (α-)2-adrenergic receptor, leading to reductions in blood pressure and heart rate, and more recently, that they can have anti-inflammatory properties. This paper discusses the clinical significance of the dexmedetomidine use, a selective (α-)2-adrenergic agonist, as a coadjuvant in general anesthesia. Actually, dexmedetomidine use is not in anesthetic routine, but this drug can be considered a particularly promising agent in perioperative multiple organ protection. 1. Introduction 1.1. Inflammatory Response and Ischemia/Reperfusion in CABG Surgery Surgery induces a variety of metabolic, endocrine, and immune changes known as the “stress response," which may lead to prolonged in-hospital stay. The clinical manifestation of this reaction includes postoperative complications such as respiratory failure, wound infections [1], myocardial damage with contractile dysfunction, renal impairment, coagulopathy, neurologic dysfunction [2], and altered liver function with an increased mortality [3]. Inflammatory response in cardiac surgical patients is produced by complex interactions with numerous pathways including generation or activation of complement, cytokines, neutrophils, thrombin, mast cells, and other multiple inflammatory mediators. Cardiopulmonary bypass responses have often been compared with the pathophysiologic changes occurring in systemic inflammatory response syndrome (SIRS) [4] and remain not fully understood. Several interlinked mechanisms could play a role in the pathological effects associated with cardiopulmonary bypass, for instance, the exposure of blood to nonphysiologic surfaces, surgical trauma, anesthesia,
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