[HSF] Allopurinol references

[DukeB60 at aol.com]

There is an article in this month's JCVTS about N-acytylcysteine in a  
randomized trial to assess whether is suppressed the oxidative radicals of  CPB  in 
patients undergoing CABG with no statistically significant  benefit.  Abstract 
below:
 
 
Effect of intravenous N-acetylcysteine on outcomes after coronary  artery 
bypass surgery: A randomized, double-blind, placebo-controlled clinical  trial 
<NOBR>Ismail El-Hamam,  ,  <NOBR>Louis-Mathieu S, , <NOBR>Michel Car,  ,  
<NOBR>Michel Pe, , <NOBR>Denis Bouc,  ,  <NOBR>Philippe , , <NOBR>Raymond Car, , 
<NOBR>Pierre  , , <NOBR>Louis P. Perrault,*  
Research Center and Department of Surgery, Montreal Heart  Institute and 
Université de Montréal, Montreal, Quebec, Canada.  
Received for publication June 8, 2005; revisions received April 25, 2006; 
accepted for  publication May 24, 2006.  
* Address for reprints: Louis P.  Perrault, MD, PhD, Montreal Heart 
Institute, 5000 Bélanger St East, Montréal,  Québec, H1T 1C8, Canada (Email: 
_louis.perrault at icm-mhi.org_ (mailto:louis.perrault at icm-mhi.org)   ).  
OBJECTIVE: N-acetylcysteine, a potent anti-inflammatory  and antioxidant 
agent, is known to decrease the production of  reactive oxygen species after 
cardiac surgery. The objective of this  study was to evaluate the effects of 
intravenous  N-acetylcysteine on clinical and biochemical outcomes after  coronary 
artery bypass surgery with cardiopulmonary bypass.  
METHODS: One hundred patients (mean age 60.5 years, range 43-78 years, 89% 
male) undergoing coronary artery bypass grafting at the Montreal Heart Institute 
were randomized to receive either  N-acetylcysteine (600 mg orally the day 
before and the morning  of the operation, a bolus of 150 mg/kg of intravenous  
N-acetylcysteine before skin incision, followed by perfusion  at 12.5 mg · kg–1 
· h–1 over 24 hours; n = 50)  or placebo (n = 50). The patients and clinical 
team were blinded to  group assignments. Preoperative characteristics were 
similar between  the two groups. Postoperative clinical data (death, myocardial  
infarction, low-output syndromes, arrhythmias, bleeding, transfusion  
requirements, and intensive care unit and hospital lengths of stay)  and biochemical 
markers (creatine kinase MB, troponin T, creatinine,  hemoglobin, and platelet 
levels) were evaluated serially over 4  days.  
RESULTS: Clinical outcomes were not significantly different between the two 
groups with regard to the incidence of death, myocardial infarction, bleeding, 
transfusion requirements, intubation time, and hospital length of stay. No 
differences were found in  postoperative biochemical markers (troponin T, 
creatine kinase MB,  creatinine, hemoglobin, and platelets) between the groups. No  
differences were observed between the groups in interleukin-6  production (P = 
not significant).  
CONCLUSIONS: Prophylactic use of N-acetylcysteine in patients  undergoing 
coronary artery bypass grafting with cardiopulmonary  bypass does not lead to 
improvement in clinical results or  biochemical markers. Further strategies to 
decrease reperfusion  injury should be devised. 
 
Edward P.  Raines, M.D., J.D.
BryanLGH Cardiothoracic Surgery
BryanLGH Medical Center  East
1600 South 48th Str.
Lincoln, Nebraska 68506
Office:  402-481-8430
Cell: 402-730-9242
Fax:  402-481-8429