[HSF] Allopurinol references

[Sherman Turnage]

Hal, et al.,

Here are references describing prospective randomized trials with  
allopurinol in cardiac surgical patients.

Castelli P, et al. J Cardiovasc Pharmacol, 1995, 25(1):119-25. 33 pts  
randomized to allopurinol vs. control.  Allopurinol group had better  
recovery of cardiac output postop.

Bochenek A, et al. Eur J Cardiothorac Surg, 1990, 4(10):538-42. 26  
pts randomized to allopurinol vs. control. Improved left ventricular  
stroke work up to 2 hrs post CPB.

Movahed A, et. al. Can J Cardiol. 1996, 12(2):138-44. 36 pts in  
randomized trial of allopurinol. Decreased level of lipid peroxidase  
byproducts and CK-MB in the allopurinol group after crossclamp release.

Coghlan JG, et al. J Thorac Cardiovasc Surg. 1994, 107(1): 248-56. 20  
pts randomized. Cardiac index improved quicker postop in the  
treatment group.

To be fair, there is one study that shows a lack of benefit of  
allopurinol. However, this study like some of those above primarily  
looked at cardiac enzyme release. I think enzyme levels are probably  
relatively insensitive markers of the oxidative stress allopurinol  
decreases. Anyway, hope the above provides some scientific rationale  
for our use of allopurinol. As Prasanna said, we see it as just one  
component of minimizing inflammatory insult to the myocardium.

W. Sherman Turnage, MD
Lighthouse Anesthesiology Consultants, PL
St. Augustine, FL