期刊
CONTEMPORARY CLINICAL TRIALS
卷 30, 期 4, 页码 380-385出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cct.2009.03.004
关键词
Cardiopulmonary bypass; Diabetes mellitus; Propofol; F2-isoprostanes; Nitric oxide synthase type III
资金
- International Anesthesia Research Society Clinical Scholar Award
- Canadian Institutes of Health Research [MOP 82757]
- Canadian Anesthesiologists' Society Dr. Earl Wynands Research Award in Cardiovascular Anesthesia
- Vancouver Coastal Health Research Institute
Diabetes mellitus is a leading cause of death globally and results in significant morbidity and mortality following surgery. After cardiac surgery, diabetic patients are especially at risk for low cardiac output syndrome, which can quadruple the risk for postoperative death. Attempts to prevent low cardiac output syndrome have focused on increasing myocardial tolerance to ischemia (preconditioning), which involves the myocardial mitochondrial ATP-regulated K(ATP) channel. G-protein initiation, nitric oxide synthase, and protein kinase C. Unfortunately, the signal transduction pathways required for preconditioning are corrupted in diabetes. Effective antioxidant intervention during ischemia-reperfusion appears important for preserving myocardial function: thus, alleviating oxidant-mediated post-ischemic injury by increasing antioxidant defenses (cardioprotection) is an alternative to preconditioning. Our previous work suggests that propofol(2,6-diisopropylphenol), an intravenous anesthetic with antioxidant potential, may confer cardioprotection. In this paper, we describe the rationale and methodology of the Pro-TECT II Study, a Phase II randomized controlled trial designed to explore the relationships of biomarkers of oxidative or nitrosative stress in diabetes, to determine the effect of propofol cardioprotection to counteract these effects in patients undergoing elective primary coronary bypass graft surgery with cardiopulmonary bypass, and to provide feasibility and sample size data needed to conduct Phase III trials. (C) 2009 Elsevier Inc. All rights reserved.
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