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October 14, 2007
9:00 AM - 11:00 AM
Room Hall D, Area C,
Endotoxin Concentration Following Cardiac Surgery with Cardiopulmonary Bypass
Yoshiko Takahashi, M.D., Mayumi Nakahara, M.D., Toru Imabayashi, M.D., Tomotsugu Yasuda, M.D., Yasuyuki Kakihana, M.D.
Anesthesiology, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
In patients who undergo cardiac surgery with cardiopulmonary bypass (CPB), endotoxin (ET) is reportedly released into the blood from intestinal bacteria because of impaired gut perfusion during CPB. However, the occurrence of endotoxemia during CPB has been still controversial. Therefore, we evaluated whether the endotoxemia was induced with appliance of CPB.

Methods: With institutional approval and informed consent, we studied 12 patients [aged 61.9 ± 18 yrs]

undergoing coronary artery bypass grafting with CPB (CABG group; n = 6). Blood samples were collected at six time-points; (1) before the operation, (2) 1 h and (3) 2 h after initiation of CPB, (4) at ICU admission, (5) on the postoperative day one (POD1) and (5) on POD2. The concentration of ET in plasma and hole blood were specially measured by Endotoxintest Wako and Beta-Gulcan Test Wako (Wako Pure Chemical Industries, Ltd., Osaka, Japan), and by entotoxin activity assay (EAA) which was used of a chemiluminometer (Autolumat LB953; EG & G. Berthold). All results are expressed as mean ± SD, with statistical evaluation by a paired-t test and unpaired-t test and repeated-measures one-way ANOVA followed by Fisher's PLSD for multicomparisons and Pearson's correlation coefficient, each value being compared with the control value.

Results: The value of ET measured by Endotoxintest Wako was not detectable at any time-point in any patient undergoing CABG. On the other hand, the values of ET measured by EAA was significantly increased during and after CPB ((1) before the operation; 0.16 ± 0.07, (2) 1 h after initiation of CPB; 0.40 ± 0.22 (P = 0.025) and (3) 2 h after initiation of CPB; 0.36 ± 0.18 (P = 0.02), (4) at ICU admission; 0.26 ± 0.11 (P = 0.1) (5) on the POD1; 0.30 ± 0.08 (P = 0.07) and (5) on POD2; 0.42 ± 0.18 (P = 0.07).

Conclusion: We measured endotoxin by using two different methods during the perioperative period of cardiac operation performed with CPB. Endotoxin was not observed with one measured method, and another method showed increase of endotoxin activity. Further examination is necessary for confirmation.

Anesthesiology 2007; 107: A564