Sevoflurane but not Propofol Induces Immunomodulatory Effects in Patients Undergoing Aortic Valve Replacement and Cardiopulmonary Bypass

Abstract

Background: Volatile anaesthetics, most of all sevoflurane, have been described as providers of myocardial preconditioning, but few articles are focused on immunomodulatory effects of these agents. We aimed to study the effects of different anaesthetic procotols with sevoflurane and propofol on immunomodulation in patients undergoing cardiopulmonary bypass (CBP). Methods: Twenty-five patients scheduled for aortic valve replacement undergoing CBP were studied and divided in three groups depending on anaesthetic protocol: sevoflurane for induction, maintenance and CBP period (group 1); propofol for induction, maintenance and CBP period (group 2); propofol for induction and CBP period and sevoflurane for maintenance before and after CBP (group 3). Blood samples were obtained at baseline, immediately after sternal closure, 24 hours, 72 hours and 7 days after surgery. TLR2 and TLR4 expression were measured in monocytes and lymphocytes, and serum levels of tumoral necrosis factor α (TNFα), Cystatin C, Reactive C Protein (PCR), Propeptide Brain Natriuretic Protein (Pro-BNP) and Interleukin (IL) 6, IL-2R and IL-8 were analyzed. Conclusions: Compared with propofol, sevoflurane anaesthesia was associated to lower expression of TLR2 in monocytes and lower serum levels of inflammatory mediators.