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The efficacy of parecoxib on systemic inflammatory response associated with cardiopulmonary bypass during cardiac surgery
Author(s) -
Wu Qingping,
Purusram Gunsham,
Wang Huiqing,
Yuan Ruixia,
Xie Wanli,
Gui Ping,
Dong Nianguo,
Yao Shanglong
Publication year - 2013
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2012.04393.x
Subject(s) - parecoxib , medicine , cardiopulmonary bypass , anesthesia , inflammatory response , cardiac surgery , placebo , troponin t , systemic inflammatory response syndrome , white blood cell , inflammation , myocardial infarction , analgesic , pathology , alternative medicine , sepsis
Aims Cardiopulmonary bypass ( CPB ) during cardiac surgery is well known to be associated with the development of a systemic inflammatory response. The efficacy of parecoxib in attenuating this systemic inflammatory response is still unknown. Methods Patients undergoing elective mitral valve replacement with CPB were assessed, enrolled and randomly allocated to receive parecoxib (80 mg) or placebo. Blood samples were collected in EDTA vials for measuring serum cytokine concentrations, troponin T, creatinekinase myocardial‐brain isoenzyme CK‐MB concentrations and white cell counts. Results Compared with the control group, IL ‐6 and IL ‐8‐values in the parecoxib group increased to a lesser extent, peaking at 2 h after the end of CPB ( IL ‐6 31.8 pg ml −1 ± 4.7 vs . 77.0 pg ml −1 ± 14.1, 95% CI −47.6, −42.8, P < 0.001; IL ‐8 53.6 pg ml −1 ± 12.6 vs . 105.7 pg ml −1 ± 10.8, 95% CI −54.8, −49.4, P < 0.001). Peak concentrations of anti‐inflammatory cytokine IL ‐10 occurred immediately after termination of CPB and were higher in the parecoxib group (115.7 pg ml −1 ± 10.5 vs. 88.4 pg ml −1 ± 12.3, 95% CI 24.7, 29.9, P < 0.001). Furthermore, the increase in neutrophil counts caused by CPB during cardiac surgery was inhibited by parecoxib. The increases in serum troponin T and CK‐MB concentrations were also significantly attenuated by parecoxib in the early post‐operative days. Peak serum concentrations of CK‐MB in both groups occurred at 24 h post‐ CPB (17.4 μg l −1 ± 5.2 vs. 26.9 μg l −1 ± 6.9, 95% CI −10.9, −8.1, P < 0.001). Peak troponin T concentrations occurred at 6 h post‐bypass (2 μg l −1 ± 0.62 vs. 3.5 μg l −1 ± 0.78, 95% CI −1.7, −1.3, P < 0.001). Conclusion Intra‐operative parecoxib attenuated the systemic inflammatory response associated with CPB during cardiac surgery and lowered the biochemical markers of myocardial injury.