Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass.

Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72) were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA) group of 11 patients (4 females and 7 males). The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumor necrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA (two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001), but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.

Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass

Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72) were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA) group of 11 patients (4 females and 7 males). The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumor necrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA (two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001), but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.

Tempo de tratamento para atingir níveis de normalidade na anemia ferropriva / Time for the recovery of the normal levels in the iron deficiency anemia

Para avaliar a efetividade e tempo para recuperação dos níveis normais de hemoglobina (Hb), hematócrito (Ht), índices hematimétricos (HCM e VCMN) foi realizado estudo retrospectivo de 576 hemogramas de 85 crianças de 1 a 6 anos, em tratamento para anemia ferropriva no Serviço de Hematologia/Oncologia d HUSM e entrevistas familiares. Os hemogramas foram realizados em aparelho STKS Coulter e os dados analisados no Programa Eplinfo. Das crianças, 21 apresentavam anemia discreta (AD), 40 anmia moderada (AM) e 24 anemia acentuada (AA). A eficácia foi avaliada considerando o incremento de Hb (IHb). Tiveram eficácia ruim 44,2% das crianças com IHb de0-1g/dL, eficácia bo 30,8% com IHb de 1-2g/dL, e muito boa 25% com IHb superior a 2g/dL de Hb. Houve relação significativa entre a Hb inicial e eficácia. No grupo AD o tempo de tratamento para atingir os níveis normais de Ht, Hb, VCM e HCM foram respectivamente 2,2 meses (+- 0,29); 2,8 meses (+- 0,46); 7,8 meses (+- 2,32); 7,5 meses (+- 19). No grupo AM: 6 meses (+- 1,1); 8,4 meses (+- 1,37); 12,5 meses (+- 198; 12,7 meses (2,14). No grupo AA:8,8 meses (+- 1,93); 10 meses (+- 1,8); 19,4 meses (+- 2,55); 19 meses (+- 2,8). Os tempos para atingir a normalidade variaram de acordo com o parâmetro utilizado e a severidade da anemia (p<0,005).