ORIGINAL ARTICLE
Year : 2014  |  Volume : 8  |  Issue : 1  |  Page : 12-20

Pentoxifylline is better than ketamine in modulating the systemic inflammatory response in patients undergoing coronary artery bypass grafting


1 Departement of Anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Departement of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence Address:
Abdelhay Ebade
MD, Assistant Professor of Anesthesia, Faculty of Medicine, Cairo University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-9090.137230

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Objective The aim of this study was to evaluate the effect of using pentoxifylline (PTX) and ketamine on serum levels of interleukin (IL)-6, IL-10, and malondialdehyde (MDA) during coronary artery bypass grafting surgery. Patients and methods The study included 60 patients, 39 men and 21 women, with a mean age of 48.6 ± 9.1 years and a mean ejection fraction (EF) of 56.7 ± 3.8%. Patients were randomly allocated into three equal groups: the control group received placebo infusion; the ketamine group received 0.5 mg/kg ketamine as an intravenous bolus dose administered after induction of anesthesia, followed by continuous infusion with 1.25 μg/kg/min ketamine until weaning from cardiopulmonary bypass (CPB); and the PTX group received 5 mg/kg PTX as an intravenous bolus dose administered after induction of anesthesia, followed by continuous infusion with 1.5 mg/kg/h PTX until weaning from CPB. Blood samples were collected from the patients after induction of anesthesia (baseline; T 0 ) and 4 h (T 1 ), 24 h (T 2 ), and 48 h (T 3 ) after aortic declamping for estimation of serum IL-6, IL-10, and MDA levels using ELISA. Results All patients showed a steadily progressive increase in serum IL-6 levels; however, both ketamine and PTX had a blunting effect on IL-6 release, manifested as nonsignificantly (P3 = 0.262 and 0.794, respectively) higher serum levels estimated at T 1 compared with T 0 , with significantly (P3 = 0.0006) lower levels compared with those in the control group. All patients showed significantly (P3 = 0.001, 0.005, and 0.028 in control, ketamine, and PTX groups, respectively) higher serum IL-6 levels at T 3 compared with T 2 , which were significantly (P3 = 0.0004, 0.0006, and 0.001 in control, ketamine, and PTX groups, respectively) higher than those at T 1 . The PTX group showed significantly lower IL-6 levels at T 2 compared with the ketamine group (P2 = 0.018). Serum IL-10 levels were significantly (P3 = 0.029, 0.0005, and 0.0007 in control, ketamine, and PTX groups, respectively) higher at T 1 compared with T 0 , with significantly higher levels in the ketamine (P1 = 0.031) and PTX (P1 = 0.0009) groups compared with the control group. Serum IL-10 levels were significantly higher in the control (P3 = 0.041), ketamine (P3 = 0.001), and PTX (P3 = 0.009) groups at T 2 compared with T 1 , with significantly higher levels in the ketamine (P1 = 0.0006) and PTX (P1 = 0.0007) groups compared with the control group and significantly higher levels in the PTX (P1 = 0.002) group compared with the ketamine group. Serum IL-10 levels were significantly lower in the control (P3 = 0.001) and ketamine (P3 = 0.0009) groups, with nonsignificantly lower (P3 = 0.136) levels in the PTX group, at T 3 compared with T 2 , with significantly higher levels in the ketamine (P1 = 0.002) and PTX (P1 = 0.0005) groups compared with the control group and significantly higher levels in the PTX (P1 = 0.0007) group compared with the ketamine group. Serum MDA levels were significantly (P3 = 0.0004, 0.0005, and 0.0004 in control, ketamine, and PTX groups, respectively) higher at T 1 compared with T 0 , with significantly higher levels in the ketamine (P1 = 0.021) and PTX (P1 = 0.0009) groups compared with the control group and significantly higher levels in the ketamine group (P2 = 0.001) compared with the PTX group. Serum MDA levels were significantly higher in the control (P3 = 0.006) and ketamine (P3 = 0.049) groups, but nonsignificantly higher in the PTX (P3 = 0.681) group, at T 2 compared with T 1 , with significantly lower levels in the PTX group (P1 = 0.003) and nonsignificantly (P1 = 0.219) lower levels in the ketamine group compared with the control group and significantly lower levels in the PTX (P2 = 0.002) group compared with the ketamine group. Serum MDA levels were nonsignificantly lower in the control (P3 = 0.732), ketamine (P3 = 0.164), and PTX (P3 = 0.128) groups at T 3 compared with T 2 , with nonsignificantly (P3 = 0.678) higher levels in the ketamine group but significantly higher (P1 = 0.003) levels in the PTX group compared with the control group and significantly lower levels in the PTX (P1 = 0.028) group compared with the ketamine group. Conclusion Using of PTX or ketamine could ameliorate the systemic inflammatory response, as well as oxidative stress response, in patients undergoing coronary artery bypass grafting with CPB and could shift the immune response to surgery toward the anti-inflammatory side. However, such effects were more pronounced with PTX than with ketamine.


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