Research Articles | Challenge Journal of Perioperative Medicine

The effects of pentoxyphiline on neurocognitive functions and neurobiochemical markers in coronary artery bypass graft surgery

Cem Erdogan, Cem Sayilgan, Lale Yuceyar, Hulya Erolcay, Dildar Konukoglu, Sinem Firtina, Ibrahim Balcioglu, Suat Omeroglu, Gokhan Ipek


DOI: https://doi.org/10.20528/cjpm.2023.02.002
View Counter: Abstract | 61 times |, Full Article | 14 times |

Abstract


Aim: Neurocognitive dysfunction is a complication of cardiopulmonary bypass (CPB). Neuron-specific enolase (NSE) and S100ß protein are markers of cerebral injury. With its beneficial rheological and anti-inflammatory properties, pentoxyphiline (PTX) is an interesting agent in cardiac surgery patients. The study was designed to evaluate the influence of prophylactic use of PTX on cognitive function and S100ß and NSE in on-pump coronary artery bypass grafting (CABG) patients.

Method: In this prospective study, 40 patients undergoing on-pump CABG and received either PTX (bolus of 5 mg kg-1) after induction of anesthesia or saline are included. Neurological examination and neuropsychologic tests, including the mini-mental state examination test (MMSET) and Benton visual retention test (BVRT), were obtained preoperatively and on the seventh postoperative day. Blood samples for analysis of S100ß and NSE were collected before anesthesia, at the end of CPB, at the 3rd hour and 24th hour postoperatively.

Results: Demographic and perioperative data were similar for the two groups. Mean cross-clamping times were 67.86±22.22 and 66.32±27.84 min, respectively. In both groups, S100ß and NSE increased significantly (p<0.01) at the end of the CPB and remained slightly increased at T2 (at the CPB exit), and T3 (at the 3rd hour after surgery) than preoperative levels (p>0.05). MMSET and BVRT performances of the two groups were similar and did not change compared to preoperative scores.

Conclusions: Coronary artery bypass surgery caused a significant increase in NSE and S100ß serum levels but with no deterioration in neuropsychological outcome assessed in the first postoperative week. Although it was reported that PTX could be a promising agent to prevent post-CPB organ dysfunction in elderly cardiac surgery patients, prophylactic use of PTX appeared to offer no advantage for cerebral protection in the age group involved in this study.


Keywords


coronary artery bypass surgery; NSE ; S100ß protein; mini-mental state examination test; benton visual retention test; pentoxyphiline

Full Text:

PDF

References


Murkin J: Protection of the brain during cardiac surgery. In: Hensley FA, Martin DE, Gravlee GP. Cardiac Anesthesia. 4th edition Philadelphia, USA 2008; 626-640.

Rasmussen LS, Christiansen M, Eliasen K, Sander-Jensen K, Moller JT: Biochemical markers for brain damage after cardiac surgery- time profile and correlation with cognitive dysfunction. Acta Anaesthesiol Scand 2002; 46: 547-551.

Grocott HP, Stafford-Smith M: Organ protection during cardiopulmonary bypass. In: Kaplan JA, Reich DL. Kaplan’s Cardiac Anesthesia. 5th edition. Philadelphia, USA 2006; 30: 985-996.

Motallebzadeh R, Kanakasabay R, Bland M, Kaski JC, Jahangiri M.: S100 protein and its relation to cerebral microemboli in on-pump and off-pump coronary artery bypass surgery European Journal of Cardio-thoracic Surgery 25 (2004) 409-414.

Day JRS, Taylor KM: The systemic inflammatory response syndrome and cardiopulmonary bypass. International Journal of Surgery (2005) 3, 129-140.

Boldt Joachim, Brosch C, Piper SN, Suttner S, Lehmann A, Werling C: Influence of prophylactic use of pentoxifylline on postoperative organ function in elderly cardiac surgery patients. Crit Care Med 2001 Vol. 29, No. 5.

Üstünsoy H, Sivrikoz C, Nurözler F, et al.: The protective role of pentoxifylline in the peripheral system during extracorporeal circulation. Turkish J Thorac and Cardiovasc Surg 2000; 8:687-9.

Bessler H, Gilgal R, Djaldetti M, Zahavi I: Effect of pentoxifylline on the phagocytic activity, cAMP levels and superoxide anion production by monocytes and polymorphonuclear cells. J Leukocyte Biology 1986;40:747- 54.

Durgut K, Hoşgör K, Görmüş N, Özergin U, Solak H: The cerebroprotective effects of pentoxifylline and aprotinin during cardiopulmonary bypass in dogs. Perfusion 2004; 19: 101-106.

Bonacchi M, Prifti E, Maiani M, Bartolozzi F, Di Eusanio M, Leacche M: Does off-pump coronary revascularization reduce the release of the cerebral markers, S-100ß and NSE? Heart Lung and Circulation 2006; 15: 314-319.

Gao F, Harris DN, Sapsed-Byrne S: Time course of neuron-specific enolase and S-100 protein release during and after coronary artery bypass grafting. Br J Anaesth 1999; Feb; 82(2): 266-7.

Krnjak L, Trunk P, Gersak B, Osredkar J: Correlation of serum S100ß concentration with hospital stay in patients undergoing CABG. Acta Clin Croat 2008; 47:221-226.

Jönsson H, Johnsson P, Bäckström M, Alling C, Dautovic-Bergh C, Blomquist S: Controversial significance of early S100ß levels after cardiac surgery. BMC Neurology 2004, 4:24.

Herrmann M, Ebert AD, Galazky I, Wunderlich MT, Kunz WS, Hunt C: Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke 2000 Mar;31(3): 645-50.

Güngen C, Ertan T, Eker E, Yaşar R: Standardize Mini Mental Test’in Türk toplumunda hafif demans tanısında geçerlilik ve güvenirliği. Türk Psikiyatri Dergisi 2002;13 (4): 273-281.

Messinis L, Lyros E, Georgiu V. Papathanasopoulos P: Benton Visual Retention Test performance in normal adults and acute stroke patients: demographic considerations, discriminant validity, and test-retest reliability. Clin Neuropsycol 2009; 23 (6): 962-77.

McGiffin DC, Kirklin JK: Cardiopulmonary bypass for cardiac surgery. In: Sabiston DC, Spencer FC, editors. Surgery of the chest. Vol.II, 6th cd. Philadelphia: WB Saunders; 1995: 1256-71.

Aberg T: Signs of brain cell injury during open heart operations: past and present. Ann Thorac Surg 1995; 59: 1312-5.

Westby S, Johnsson P, Parry AJ, Blomqvist S, Solem JO, Alling C, et al.: Serum S100- protein: a potential marker for cerebral events during cardiopulmonary bypass. Ann Thorac Surg 1996; 61: 88-92.

Taggart DP, Mazel JW, Bhattacharya K, et al.: Comparison of serum S100 levels during CABG and intracardiac operations. Ann Thorac Surg 1997; 66: 492-6.

Jönnsson H, Johnsson P, Alling C, Backstrom M, Bergh C, Blomquist S: S100ß after coronary artery surgery: release pattern, source of contamination and relation to neuropsychological outcome. Ann Thorac Surg 1999; 68: 2202-8.

Farsak B, Günaydın S, Yorgancıoğlu C, Zorlutuna Y: Elevated levels of S100ß correlate with neurocognitive outcome after cardiac surgery. J Cardiovasc Surg 2003; 44: 31-5.

Wimmer-Greinecker G, Matheis G, Brieden M, Dietrich M, Oremek G, Wepstal K, Winkelmann BR, Moritz A: Neuropsychological change after cardiopulmonary bypass for coronary artery bypass grafting. Thorac Cardiovasc Surg 1998; 46: 207-212.

Hermann Heinze, Carmen Rosemann, Christian Weber, Gerhard Heinrichs, Ludger Bahlmann, Martin Misfeld, Matthias Heringlake, Wolfgang Eichler: A single prophylactic dose of pentoxifylline reduces high dependency unit time in cardiac surgery a prospective randomized and controlled study. European Journal of Cardio-thoracic Surgery 32 (2007) 83-89.

Sambhunath Das, Suparna Kailash, Manu Mehta, Akshya Kumar Bisoi: Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass. Journal of Neuroanaesthesiology and Critical Care 2015; 1: 44-50.


Refbacks

  • There are currently no refbacks.