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Does Pharmacotherapy Influence the Inflammatory Responses During Cardiopulmonary Bypass in Children?

Kapitein, Berber MD, PhD*; van Saet, Anne-Wil MD; Golab, Hanna D. PhD; de Hoog, Matthijs MD, PhD*; de Wildt, Saskia MD, PhD*; Tibboel, Dick MD, PhD*; Bogers, Ad J. J. C. MD, PhD

Journal of Cardiovascular Pharmacology: August 2014 - Volume 64 - Issue 2 - p 191–197
doi: 10.1097/FJC.0000000000000098
Review Article

Abstract: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response syndrome (SIRS) by factors such as contact of the blood with the foreign surface of the extracorporeal circuit, hypothermia, reduction of pulmonary blood flow during CPB and endotoxemia. SIRS is maintained in the postoperative phase, co-occurring with a counter anti-inflammatory response syndrome. Research on the effects of drugs administered before the surgery, especially in the induction phase of anesthesia, as well as drugs used during extracorporeal circulation, has revealed that they greatly influence these postoperative inflammatory responses. A better understanding of these processes may not only improve postoperative recovery but also enable tailor-made pharmacotherapy, with both health and economic benefits. In this review, we describe the pathophysiology of SIRS and counter anti-inflammatory response syndrome in the light of CPB in children and the influence of drugs used on these syndromes.

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*Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands;

Department of Anesthesiology, Intensive Care Unit, Erasmus MC, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; and

Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, the Netherlands.

Reprints: Berber Kapitein, MD, PhD, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, Dr Molewaterplein, 60, 3015 GJ Rotterdam, the Netherlands (e-mail:

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received October 22, 2013

Accepted March 13, 2014

© 2014 by Lippincott Williams & Wilkins.