Effect of Selenium on Ischemia-Reperfusion Injury in the Coronary Artery Bypass Graft Surgery: A Clinical Trial Study (original) (raw)
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The Effect of Selenium on Ischemia-Reperfusion Injury
Journal of Craniofacial Surgery, 2016
Background: The aim of this study is to investigate effects of selenium and enlighten the possible mechanism of action in a rat transverse musculocutaneous flap model following ischemiareperfusion injury. Materials and Methods: In this study, an experimental model, which mimicked free tissue transfer, was applied. Twenty-four male Wistar Albino rats were divided into a control group (N ¼ 12), and a selenium treated group (N ¼ 12). A superiorly based transverse rectus abdominis musculocutaneous (TRAM) flap was elevated and an ischemic insult for 4 hours was given. In selenium treated group (Group 2), sodium selenite (0.625 mg/kg) was injected intraperitoneally (i.p), 2 hours before the induction of ischemia. Six rats from each group were sacrificed at 24 hours after the operation and malonyldialdehyde (MDA), nitric oxide (NO), and glutathione (GSH) levels were measured biochemically, whereas the intensity of neutrophil infiltration was evaluated. For the rest of the rats in Group 2, sodium selenite was injected at the same dose everyday to the postoperative 10th day, in which the remaining 6 rats from each group were sacrificed. On postoperative 10th day, flap viability was assessed along with the evaluation of intensity of neovascularization. Results: In Group 1, MDA levels were higher significantly (P < 0.05) when compared with Group 2. No statistical difference, however, was found for NO (P > 0.05), and GSH (P > 0.05) levels among Group 1 and 2. Neutrophil infiltration was more intense in Group 1, when compared with Group 2 whereas neovascularization was more abundant in samples of Group 2. Group 2 shows higher average flap surface areas when compared with Group 1 (P < 0.05). Discussion: The results of this study demonstrated the preventive effect of selenium against ischemia-reperfusion injury by reducing tissue necrosis in muscle flaps possibly by decreasing MDA, increasing neovascularization, and decreasing neutrophil infiltration, thus suppressing inflammation.
PloS one, 2014
Cardiac surgery is accompanied by an increase of oxidative stress, a significantly reduced antioxidant (AOX) capacity, postoperative inflammation, all of which may promote the development of organ dysfunction and an increase in mortality. Selenium is an essential co-factor of various antioxidant enzymes. We hypothesized a less pronounced decrease of circulating selenium levels in patients undergoing off-pump coronary artery bypass (OPCAB) surgery due to less intraoperative oxidative stress. In this prospective randomised, interventional trial, 40 patients scheduled for elective coronary artery bypass grafting were randomly assigned to undergo either on-pump or OPCAB-surgery, if both techniques were feasible for the single patient. Clinical data, myocardial damage assessed by myocard specific creatine kinase isoenzyme (CK-MB), circulating whole blood levels of selenium, oxidative stress assessed by asymmetric dimethylarginine (ADMA) levels, antioxidant capacity determined by glutathi...
Frontiers in Cardiovascular Medicine
IntroductionThe oxidative damage suffered in cardiac surgery is associated with declining trace elements which lead to the development of multi organ dysfunction (MOD), acute kidney injury (AKI), or increased length of hospital stay (LOS). Recent evidence shows the cardioprotective role of the trace element selenium as it mitigates worsening outcomes post cardiac surgery. Hence, this meta analysis aims to investigate the role of selenium in lowering cardiac surgery related adverse outcomes.MethodsLiterature search of five electronic databases was performed from the inception of the paper till 29th July, 2023. Eligibility criteria included; (a) randomized clinical trials with Adult patients (≥18 years) undergoing cardiac surgery (b) intervention with selenium pre or/and postoperatively; (c) a control group of a placebo, normal saline, or no selenium. Outcomes of interest include postoperative mortality, LOS in the hospital and Intensive Care Unit (ICU), AKI, troponin I, and Creatinin...
Effect of Selenium on Stress Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial
Anesthesiology and Pain Medicine, 2017
Background: In spite of significant improvements in surgical and anesthetic techniques, acute stress response to surgery remains a main cause of mortality and morbidity in coronary artery bypass graft (CABG) surgery patients. Therefore, doing research to find safe and effective modalities with more cardio protective properties seems necessary. Objectives: In this study, we sought to determine whether intravenous injection of 600 µg Selenium (Se) prior to surgery would limit stress response measured by blood sugar. Methods: This double blind clinical trial was conducted at a referral center of cardiac surgery affiliated to Guilan University of Medical Sciences (GUMS) from June 2015 to October 2015. 73 eligible patients candidate for elective isolated CABG surgery were enrolled in the trial. They were randomly allocated to either Se group (n = 36) receiving 600 µg Se prior to surgery or control group (n = 37). Our evaluation was based on blood sugar (BS) which was measured at four point times, including before induction of anesthesia (T0), at the end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery. Results: The data obtained from 73 patients in group S (n = 36) and group C (n = 37) were analyzed. There was no significant difference between the two groups regarding the baseline characteristics. In both groups, a sharp rise in BS levels was observed following CPB (P = 0.0001). Although the trend of BS changes was remarkable in both groups (P = 0.0001), there was no statistically significant difference between the groups at all point times including T0 (P = 0.45), T1 (P = 0.48), T2 (P = 0.92), and T3 (P = 0.42). Within the study time, our patients were monitored for any adverse effect but nothing was observed. Conclusions: This investigation showed that intravenous single dose of 600 µg Se was safe in CABG patients, but had no positive effect on stress response to surgery.
Jundishapur Journal of Natural Pharmaceutical Products
Background: Coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB) triggers a profound systemic inflammatory response and sympathetic nervous system activation translated into post-operative adverse outcomes. Objectives: The current study aimed at determining whether preparative use of selenium could reduce the severity of inflammatory reaction to surgery. Methods: The current randomized, double-blind clinical trial was conducted at the Department of Cardiac Surgery of Dr. Heshmat Hospital; a referral center affiliated to Guilan University of Medical Sciences (GUMS), Rasht, Iran. From May 2015 to September 2015 one hundred and fourteen patients who were candidates for elective CABG were randomly recruited to receive either an intravenous bolus of 600 µg Se before induction of anesthesia in the group S (n = 56) or normal saline as placebo in the group C (n = 58). To measure white blood cells (WBC) serum levels, blood samples were collected preoperatively (T0) and three times after CPB initiation immediately after the end of CPB (T1), as well as 24 (T2) and 48 hours (T3) after surgery. Statistical tests including chi-square, the Kruskal-Wallis, and independent t tests, as well as repeated measurement ANOVA were used to analyze the data. Results: There was no significant difference between the two groups regarding the baseline characteristics (P = 0.0512). There was no significant difference between the two groups in other four time points; T0 (P = 0.0512), T1 (P = 0.571), T2 (P = 0.974), and T3 (P = 0.215), although the trend of changes was statistically significant in each group (P = 0.0001), the intergroup comparisons showed no significant changes (P = 0.166). Conclusions: There was no strong evidence that a single-dose of Se could reduce inflammation following CABG surgery.
Nutrition, 2013
Objectives: We recently reported that cardiac surgical patients in our institution exhibited low selenium blood levels preoperatively, which were further aggravated during surgery and independently associated with the development of postoperative multiorgan failure. Low circulating selenium levels result in a decreased antioxidant capacity. Both can be treated effectively by sodium-selenite administration. Little is known about the kinetics of exogenously administered sodium-selenite during acute perioperative oxidative stress. The aim of this study was to assess the effects of perioperative high-dose sodium-selenite administration on selenium blood concentrations in cardiac surgical patients. Methods: One hundred four cardiac surgical patients were enrolled in this prospective observational trial. Patients received an intravenous bolus of 2000 mg selenium after an induction of anesthesia and 1000 mg selenium every day further during their intensive care unit (ICU) stay.