Effects of Low-dose Selenium on the Inflammatory Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial
نویسندگان
1 MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
2 MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
3 MD, Assistant Professor of Cardiac Surgery, Department of Cardaic Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
4 MD, Assistant Professor of Cardiac Surgery, Department of Cardaic Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
5 MD, Associate Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran
6 PhD, Assistant Professor of Biostatistic, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran
7 MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
8 MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
9 MD, Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran
doi
چکیده
Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction,leading to the development of myocardial damage and dysfunction. It is suggested that selenium (Se), an essential trace element,has a protective role against oxidative stress. Decreased intraoperative Se levels might be an independent predictive factor for postoperativemultiorgan failure. In spite of its proposed advantages, however, the optimal timing and dosage are not well known.Objectives: To determine whether 600 g of intravenous Se administration before induction of anesthesia for CABG surgery couldattenuate inflammatory reactions in an Iranian population.Methods: This randomized triple-blind clinical trial took place in the department of cardiac surgery of an academic hospital affiliatedwith Guilan University of Medical Sciences (GUMS) from May 2015 to September 2015. Eighty-eight eligible patients scheduledfor elective on-pump CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received eitheran intravenous bolus of 600 g Se before induction of anesthesia, or normal saline as a placebo. We had four measurementtime-points: just before induction of anesthesia (T0), immediately after the end of CPB (T1), 24 hours after surgery (T2), and 48 hoursafter surgery (T3). Interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF- ), and C-reactive protein (CRP) serum levels were measuredusing the enzyme-linked immunosorbent assay (ELISA).Results: Data from a total of 81 patients were analyzed: group S (n = 41) and group C (n = 40). There was no significant differencebetween the two groups with regard to baseline characteristics. In both groups, CPB caused markedly increased IL-6, TNF- , andCRP plasma concentrations compared with baseline (P = 0.0001). However, the pattern of changes was not significantly differentbetween group S (P = 0.068) and group C (P = 0.26). The IL-6 and TNF- change trends were significant in each group (P=0.0001).However, comparing the two groups showed no significant difference. With regard to IL-6, there was no significant difference betweenthe two groups at the time-points of T1 (P = 0.34), T2 (P = 0.17), and T3 (P = 0.056), and the same was found for TNF- at T1(P = 0.34), T2 (P = 0.17), and T3 (P = 0.056). With regard to CRP, the trend of the changes was significant in each group (P = 0.0001).However, comparing two groups showed a borderline significant difference between them at T1 (P = 0.039), but not at T2 (P = 0.075)or T3 (P = 0.11).Conclusions: This study revealed that the administration of 600 g of intravenous Se immediately before induction of anesthesiawas safe, but when compared to a placebo, no predominant clinical effects or modifications in the systemic inflammatory responseinduced by on-pump CABG were observed.
