The systemic inflammatory response syndrome (SIRS) occurs in the cardiac surgery more often with the use of CPB. It is due to the contact of the blood with non-endothelial surfaces and, later to reperfusion. This contact leads to the release of substances such as anaphylotoxins, which are activated by the complement factor, and stimulate the production of pro-inflammatory cytokines (IL-1, IL-6, TNF-a). Cytokines are responsible for induction of fever, neutrophilia with increase of adhesiveness between neutrophils and mocytes and, they act synergetically stimulating the production of other interleukins (IL-6, IL-8). It is observed that intestinal ischemia secondary to CPB, causes the production of IL-6, TNF-a, IL-1 in the intestinal epithelium and, reperfusion post CPB induces the expression of IL-1 and TNF-a in the vascular endothelium that can generate a dysfunction able to injure cardiomyocytes. Following the post-CPB cascade of reactions, the adult respiratory distress syndrome is mediated by IL-8, found the at alveolar level. The brain and the liver can also be affected by ischemia/reperfusion phenomena and, once more, it is shown that interleukins (IL-8 and IL-13, respectively) have an important role in the course of SIRS- related events. CPB and anesthesia techniques can influence interleukin activity. There is not a consensus regarding preventive or treatment therapies for complications from SIRS. Possible choices are: intervention at the level of inflammation mediators, digestive decontamination procedures, use of drugs such as indometacin or steroids. The regulation of the inflammatory process, generally depends on the balance between anti- and pro- inflammatory cytokines. These later are detectable in normal individuals whereas the others only manifest locally or are almost inexistent. We conclude that the increase of the concentration of pro-inflammatory interleukins in the organism is expected during important surgical intervention. Such an increase will bring complications if it is exacerbated and, the organism is debilitated.
Extracorporeal circualtion; Interleukins; Cardiac surgical procedures
