Cardiac surgery with cardiopulmonary by pass, CPB, stimulates endotoxemia and a whole body inflamatory response, with the subsequent release odf cytokines and other inflammatory mediators.While catastrophic organ system dysfunction was common with the inceptionof CPB, advances in anesthetic and surgical techniques now allow the majorityn of patients to undergo cardiac surgery without substantial morbidity.

Resently, indications for cardiac surgery have expanded to inclide more critically ill patients, many with acute ischemic syndromes.

Attention has again turned to improving myocardial protection and minimizing the myoacrdial dysfunction, witch continues to be observed following CPB with aortic cross-clamping and cardioplegia.