The effect of amiodarone against the damage due to ischemic reperfusion during the surgery of coronary artery bypass graft with cardio-pulmonary bypass

The Effect Of Amiodarone Against The Damage Due To Ischemic Reperfusion During The Surgery Of Coronary Artery Bypass Graft With Cardio-Pulmonary BypassThe term of ischemic reperfusion injury represents the metabolic and functional changes after the reperfusion of ischemic tissue area.Various antioxidant drugs are used to minimize the damage due to reperfusion injury and to prevent cardiac tissue during cardiac surgery. Amiodarone is a drug oftenly used in the treatment of arythmia. In recent years, the antioxidant property of amiodarone is also known. In this study, we aimed to evaluate the effect of high dose of oral amiodarone which was effective in the treatment of preoperative atrial fibrillation, in the prevention of reperfusion injury during cardio-pulmonary bypass surgery.Twenty patients undergoing coronary artery bypass graft surgery with cardio-pulmonary bypass were included in the study. The subjects were divided into two groups (control subjects, n=10, and amiodarone group, n=10). The control subjects were not recieved any drug. The patients received 200 mg amiodarone (Cordarone, 200 mg Sanofi - Turkey) on preoperative day, 1600 mg amiodarone on the first day (in four divided doses), 600 mg amiodarone on the surgery day (in three divided doses), and 800 mg amiodarone for four days after the surgery (in two divided doses). The total dose of amiodarone was 6 gr. Hemodynamical changes of all patients were measured four times; before the induction of anesthesia (T1), before CPB (T2), after protamine (T3), and at 24th hour after the surgery (T4). Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and nitric oxide (NO) values were measured for biochemical evaluation of oxidative stress before the induction of anesthesia (T1), during CPB (T2), five minutes after the clamp was removed (T3), after protamine (T4) and at 1. (T5), 3. (T6) and 5. (T7) postoperative days.No side effect due to drug was observed. Heart rate was found more decreased in amiodarone group at T1 and T2 stages when compared with controls (p<0.05). Low MDA values were found in amiodarone group at all stages but the difference was not statistically significant. The effect of amiodarone on CAT, SOD and GSH-Px enzymes was not statistically significant, but the values of NO were found significantly increased in amiodarone group at all stages except T1 (p<0.05).As a result, amiodarone, an antiarythmic drug used routinly in open heart surgery, may also have value to prevent ischemic reperfusion tissue injury.Key words: Amiodarone, coronary artery bypass surgery, ischemic reperfussion injury