IMPORTANCE OF ALLOPURINOL IN CABG SURGERY
INTRODUCTION
⚫ Ischemia/reperfusion injury during routine bypass grafting results in a
measurable depression in early postoperative cardiac function
(myocardial stunning) in up to 50% of patients.
⚫ Myocardial stunning is widely held to result from the unchecked free
radical activity and to be amenable to anti-free radical interventions.
⚫ Oxygen-derived free radicals constitute one major part of the
etiologic factors for cardiac onset harmful events.
⚫ Allopurinol in combination with Vitamin E and C is able to reduce
the generation of free radicals.
⚫ The xanthine oxidase inhibitor allopurinol has been suggested to have
pleiotropic effects that are likely to reduce the incidence of
myocardial infarction (MI) in individuals at risk.
⚫ Xanthine oxidase inhibition exerts its beneficial effects by reducing
the level of free radical activity associated with reperfusion during
coronary artery bypass grafting
Why is a free radical scavenger necessary for patients ungergoing
Coronary Artery Bypass Graft surgery?
➢ Oxidative injury in CABG surgery is integral to ischemia-reperfusion
of the myocardium.
➢ Coronary artery bypass can initiate a systemic inflammatory response
from blood contact with extracorporeal surfaces.
➢ Besides the release of various stress hormones, cytokines and
chemokines, etc., it causes the release of reactive oxygen species
(ROS).
➢ These mediators may cause consumptive coagulopathy, interstitial
fluid shifts, generate a host of microemboli and result in temporary
dysfunction of nearly every organ.
INTRODUCTION
⚫ Ischemia/reperfusion injury during routine bypass grafting results in a
measurable depression in early postoperative cardiac function
(myocardial stunning) in up to 50% of patients.
⚫ Myocardial stunning is widely held to result from the unchecked free
radical activity and to be amenable to anti-free radical interventions.
⚫ Oxygen-derived free radicals constitute one major part of the
etiologic factors for cardiac onset harmful events.
⚫ Allopurinol in combination with Vitamin E and C is able to reduce
the generation of free radicals.
⚫ The xanthine oxidase inhibitor allopurinol has been suggested to have
pleiotropic effects that are likely to reduce the incidence of
myocardial infarction (MI) in individuals at risk.
⚫ Xanthine oxidase inhibition exerts its beneficial effects by reducing
the level of free radical activity associated with reperfusion during
coronary artery bypass grafting
Why is a free radical scavenger necessary for patients ungergoing
Coronary Artery Bypass Graft surgery?
➢ Oxidative injury in CABG surgery is integral to ischemia-reperfusion
of the myocardium.
➢ Coronary artery bypass can initiate a systemic inflammatory response
from blood contact with extracorporeal surfaces.
➢ Besides the release of various stress hormones, cytokines and
chemokines, etc., it causes the release of reactive oxygen species
(ROS).
➢ These mediators may cause consumptive coagulopathy, interstitial
fluid shifts, generate a host of microemboli and result in temporary
dysfunction of nearly every organ.
