Effect of Fluid Balance on Oxidant and Antioxidant Balance During Cardiopulmoner Bypass

Abstract

Background: We aim to contribute to open heart surgery by revealing how different fluids used as prime solution during Cardiopulmonary Bypass (CPB) affect oxidative stress. Materials and Methods: A total of 30 patients, 21 men and 9 women, who underwent open heart surgery for various reasons were included in this study. Patients according to the prime solutions used 1. Group: Lactic Ringer was divided into two groups as 2 Groups: Isolyte S. A total of 4 blood samples were taken from these patients after anesthesia induction, after cross-clamping during CPB, on the 1st day and the 5th day after the operation. Total antioxidant stress (TAS), total oxida-tive stress (TOS) and oxidative stress index (OSSI) were studied from the samples taken. The results were evaluated statistically. Results: Samples collected in this study were compared before prime solution (before CPB) and after CPB. In the group using Ringer Lactate (RL) on the 5th day postoperatively, the TOS value was statistically significantly lower than the preoperative period (p=0.015). Again, when the OSI values were compared, it was seen that the OSI value of the Ringer Lactate (RL) group was statisti-cally significantly lower (p=0.032). Conclusions: As a result of our study, it was seen that the TOS and OSI values of the two types of prime solutions (Ringer Lactate and Isolayt S) frequently used during Cardiopulmonary Bypass (CPB) were lower in the Ringer Lactate (RL) group and superior in the Isolayt S group.

Kardiyopulmoner Bypass’ta Sıvı Dengesinin Oksidan ve Antioksidan Denge Üzerine Etkisi

Abstract

Amaç: Kardiyopulmoner Bypass (KPB) sırasında prime solüsyonu olarak kullanılan farklı sıvıların oksidatif stresi nasıl etkilediğini ortaya koyarak açık kalp cerrahisine katkı sağlamayı amaçlıyoruz. Yöntem: Bu çalışmaya çeşitli nedenlerle açık kalp ameliyatı geçiren 21 erkek ve 9 kadın olmak üzere toplam 30 hasta dahil edildi. Hastalar kullanılan prime solüsyonlarına göre 1. Grup: Laktatlı Ringer, 2 Grup: Isolyte S olarak iki gruba ayrıldı. Bu hastalardan anestezi indüksiyonu sonrası, KPB sırasında cross-klemp takıldıktan sonra, ameliyat sonrası 1. gün ve 5. gün olmak üzere toplam 4 kan alındı. Alınan numunelerden total antioksidan stres (TAS), total oksidatif stres (TOS) ve oksidatif stres indeksi (OSİ) çalışıldı. Sonuçlar istatistiksel olarak değerlendirildi. Materyal ve Metod: Bu çalışmada toplanan numuneler prime solüsyonu verilmeden önce (KPB önce) ve KPB’ dan sonrası karşılaştırıldı. Postoperatif 5. gün Ringer Laktat (RL) kullanan grupta TOS değeri preoperatif döneme göre istatistiksel olarak anlamlı derecede düşüktü (p=0,015). Yine OSİ değerleri karşılaştırıldığında Ringer Laktat (RL) grubunun OSİ değerinin istatistiksel olarak anlamlı derecede daha düşük olduğu görüldü (p=0,032). Sonuç: Çalışmamızın sonucunda Kardiyopulmoner Bypass (KPB) sırasında sıklıkla kullanılan iki tip prime solüsyonun (Ringer Laktat ve İsolayt S) TOS ve OSI değerlerinin Ringer Laktat (RL) grubunda daha düşük, Isolayt S grubundan daha üstün olduğu görüldü. Aim: We aim to contribute to open heart surgery by revealing how different fluids used as prime solution during Cardiopulmonary Bypass (CPB) affect oxidative stress. Material and Methods: A total of 30 patients, 21 men and 9 women, who underwent open heart surgery for various reasons were included in this study. Patients according to the prime solutions used 1. Group: Lactic Ringer was divided into two groups as 2 Groups: Isolyte S. A total of 4 blood samples were taken from these patients after anesthesia induction, after cross-clamping during CPB, on the 1st day and the 5th day after the operation. Total antioxidant stress (TAS), total oxidative stress (TOS) and oxidative stress index (OSSI) were studied from the samples taken. The results were evaluated statistically. Results: Samples collected in this study were compared before prime solution (before CPB) and after CPB. In the group using Ringer Lactate (RL) on the 5th day postoperatively, the TOS value was statistically significantly lower than the preoperative period (p=0.015). Again, when the OSI values were compared, it was seen that the OSI value of the Ringer Lactate (RL) group was statistically significantly lower (p=0.032). Conclusions: As a result of our study, it was seen that the TOS and OSI values of the two types of prime solutions (Ringer Lactate and Isolayt S) frequently used during Cardiopulmonary Bypass (CPB) were lower in the Ringer Lactate (RL) group and superior in the Isolayt S group.

Keywords

• Kardiyopulmoner Bypass
• sıvı Dengesi
• Oksidan ve Antioksidan Denge
• Prime Solüsyonu
• Cardiopulmonary Bypass
• Fluid Balance
• Oxidant and Antioxidant Balance
• Prime Solution

References

1. 1. Paç M, ed. Kalp ve Damar Cerrahisi 1 ed. MN Medikal& Nobel Basım Yayın Tic. ve San. Ltd. Şti., P. Ankara, 2004;115-151, 116-121,14.
2. 2. Esener Z. Klinik anestezi 2. İstanbul: Logolar. Kardiyopulmo-ner bypass, ekstrakorporeal. 1997;293–293.
3. 3. Hessel EA. Kardiyopulmoner baypasta yenilikler. J Kardiyoto-rak Vasc Anest. 2019; 33:2296–2326.
4. 4. Maha AA, Mohamed S. Selection of optimal quantity of hyd-roxyethyl starch in the cardiopulmonary bypass pri-me. Perfusion. 2004; 19 (1): 41-45.
5. 5. Kayhan Z. Klinik anestezi 3. İstanbul: Logolar. Kardiyovasküler sistem ve anestezi. 2004; 307–351.
6. 6. Hessel EA, Edmunds LH Jr. Extracorporeal Circulation: perfu-sion Systems. In: Cardiac Surgery in the Adults. Ed: Cohn LH, Edmunds LH Jr. 2nd ed. New York: McGraw-Hill; 2003;317-338.
7. 7. Peluso I, Morabito G, Urban L, Ioannone F, Serafini M. Oxida-tive stress in atherosclerosis development: the central role of LDL and oxidative burst. Endocr Metab Immune Disord Drug Targets. 2012; 12(4): 351–60.
8. 8. Gulcin I. Antioxidant and antiradical activities of L-Carnitine. Life Sci. 2006; 78(8): 803–11.

9. 9. Erel O. A novel automated direct measurement method for total antioxidant capacity using a new generation, more stab-le ABTS radical cation. Clin Biochem. 2004; 37(4): 277-85
10. 10. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005; 38(12): 1103-11.
11. 11. Ailawadi G, Zacour RK. Cardiopulmonary by-pass/extracorporeal membrane oxygenation/left heart by-pass: Indications, techniques, and complications. Surg Clin North Am. 2009;89:781-96.
12. 12. CSH Ng and S. Wan. Limiting the inflammatory response to cardiopulmonary bypass: pharmaceutical strategies. Current Opinion in Pharmacology. 2012; 12(29): 155–9.
13. 13. TA Pearson, GA Mensah, RW Alexander et.al. Markers of inflammation and cardiovascular disease: application to clini-cal and public health practice: a paper for healthcare profes-sionals from the centers for disease control and prevention and the American Heart Association. Circulation. 2003; 107(3), p. 499–511.
14. 14. Warren OJ, Smith AJ, Alexiou C, et.al. Athanasiou T: The inflammatory response to cardiopulmonary bypass: part 1-mechanisms of pathogenesis. J Cardiothorac Vasc Anesth. 2009;23: 223-31.
15. 15. Warren OJ, Watret AL, de Wit KL, et.al. The inflammatory response to cardiopulmonary bypass: part 2-anti-inflammatory therapeutic strategies. J Cardiothorac Vasc Anesth. 2009;23: 384-93.
16. 16. LF Miles, TG Coulson, C. Galhardo, F. Falter Pump priming and anticoagulation in cardiac surgery: results of the global cardi-opulmonary bypass study Anesthesia Analysis. 2017; 125: 1871 – 77.
17. 17. Niemi TT, Suojaranta-Ylinen RT, Kukkonen SI, Kuitunen AH. Gelatin and hydroxyethyl starch, but not albumin, impair he-mostasis after cardiac surgery. Anesth Analg. 2006;102:998-1006.
18. 18. Lobo DN, Stanga Z, Simpson JA, Anderson JA, Rowlands BJ, Allison SP. Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on ha-ematological parameters and serum biochemistry in normal subjects: a double-blind crossover study. Clin Sci Lond 2001;101:173-9
19. 19. Reid F, Lobo DN, Williams RN, Rowlands BJ, Allison SP. (Ab)normal saline and physiological Hartmann’s solution: a randomized double-blind crossover study. Clin Sci Lond 2003;104:17-24.
20. 20. Boldt J. Volume Therapy in Cardiac Surgery: Does the Kind of Fluid Matter? Journal of Cardiothoracic and Vascular Anest-hesia; 113: 752-63, 1999. 45. Stein L, Beraud JJ, Morıssette M, Da Luz P, Weıl MH, Shubın H. Pulmonary edema during volu-me infusion. Circulation; 52: 483-89, 1975.
21. 21. Dhalla NS, Elmoselhi AB, Hata T, Makino N. Miyokardiyal antioksidanların iskemi-reperfüzyon hasarı durumu. Kardiyo-vasküler Res.2000; 47: 446-456.
22. 22. Çekiç E. Ekstrakorporeal Dolaşımda Başlangıç Sıvısı (Priming Volüm) Olarak Multipl Elektrolit Solüsyonu (Isolyte-S) ve Rin-ger Laktat (Bozer Solüsyonu) Kullanılan Vakaların Karşılaştırıl-ması. 1993. Uzmanlık Tezi, Ankara Haceıtepe Üniversitesi Tıp Fakültesi Toraks Ve Kalp-Damar Cerrahisi Anabilim Dalı.
23. 23. M. Zakkar, G. Guida, M.-S. Suleiman, and G. D. Angelini. Cardiopulmonary bypass and oxidative stress. Oxidative Me-dicine and Cellular Longevity. 2015; 2015:189863(8).