Effects of nitric oxide on sympathoadrenal system activity in patients with ischemic heart disease in coronary artery bypass grafting

Aim. To investigate changes in laboratory parameters of sympathoadrenal system activity and β-adrenergic receptor reactivity of erythrocyte membranes (β-ARMe) in ischemic heart disease (IHD) patients with clinical forms of arterial hypertension of high cardiovascular risk during coronary artery bypass grafting with anesthetic management including nitric oxide.

Materials and мethods. In this randomized study with parallel distribution, 36 patients (male – 66.7%; average age – 68 [63; 70] years) with IHD and clinical forms of arterial hypertension of high cardiovascular risk were enrolled. According to the indications, all patients underwent elective coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC). Patients were randomly divided into the main and control groups. Patients of the main group intraoperatively received NO at the concentration of 80 ppm first in the breathing circuit and then in the ECC circuit. Patients of the control group underwent CABG with standard mechanical lung ventilation and ECC. Before connecting to the ECC, at the end of ECC, and 1 day after CABG, all patients underwent clinical, laboratory, and instrumental tests in accordance with the clinical standards, β-ARMe was assessed, and the concentration of norepinephrine and epinephrine in the blood plasma was determined by ELISA.

Results. At the presurgical stage and 1 day after CABG, the groups did not differ in clinical and biochemical parameters. At the presurgical stage, the median values of β-ARMe in the main and control groups slightly exceeded the upper limits of normal and did not differ significantly. CABG was not accompanied by changes in β-ARMe in the control group. Intrasurgical NO donation also did not affect the level of β-ARMe. One day after CABG, neither intergroup differences in β-ARMe nor significant changes in the parameter during follow-up in each group were noted. In both control and main groups, a significant increase in the levels of epinephrine and norepinephrine was detected 1 day after CABG compared to the baseline level. At the same time, there were no intergroup differences in the level of catecholamines either before ECC or 1 day after CABG.

Conclusion. In cardiac surgery with extracorporeal circulation, the use of NO for the purpose of organ protection does not affect the level of β-ARMe and changes in the mediator response of the sympathetic system to stress in patients with IHD and clinical forms of hypertension of high cardiovascular risk.

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