New aspects concerning the regulation of the postoperative acute phase reaction during cardiac surgery

Berger, D.; Bölke, Edwin; Huegel, Heino; Seidelmann, M.; Hannekum, A; Beger, H. G.

doi:10.1016/0009-8981(95)06105-m

Cited by 35 publications

(27 citation statements)

References 43 publications

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“…Endotoxemia is common during and after numerous types of surgery and is especially associated with cardiopulmonary and thoracoabdominal procedures [86][87][88]. Even general anesthesia has been reported to induce endotoxemia [89], and interrupting the aortic blood supply to the gut is linked to increased intestinal permeability and the appearance of endotoxin in plasma [86].…”

Section: Surgical Patientsmentioning

confidence: 99%

Neutrophil migration during endotoxemia

Wagner

Roth

1999

Journal of Leukocyte Biology

177

125

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Endotoxemia is marked by a global activation of inflammatory responses, which can lead to shock, multiple organ failure, and the suppression of immune and wound healing processes. Neutrophils (PMNs) play a central role in some of these responses by accumulating in tissues and releasing reactive oxygen species and proteases that injure host structures. This review focuses on altered PMN migratory responses that occur during endotoxemia and their consequences in the development of pulmonary infection. The inflammatory mediators that might be responsible for these altered responses are discussed. The oxidant potential of PMNs is increased after exposure to endotoxin both in vitro and during clinical and experimental endotoxemia. However, other functions such as chemotaxis and phagocytosis are often depressed in these same cells. Endotoxin exposure renders PMNs hyperadhesive to endothelium. The sum of these effects produces activated inflammatory cells that are incapable of leaving the vasculature. As such, the endotoxic PMN is more likely to promote tissue injury from within microvascular beds than to clear pathogens from extravascular sites. Moreover, the functional characteristics of endotoxic PMNs are similar to those observed during trauma, burn injury, sepsis, surgery, and other inflammatory conditions. Accordingly, several clinical conditions might have a common effector in the activated, yet migratorially dysfunctional, PMN. Direct effects of endotoxin on PMNs as well as effects of endogenous mediators released during endotoxemia are discussed. Understanding PMN behavior during endotoxemia may provide basic and critical insights that can be applied to a number of inflammatory scenarios. J. Leukoc. Biol. 66: 10-24; 1999.

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Section: Surgical Patientsmentioning

confidence: 99%

Neutrophil migration during endotoxemia

Wagner

Roth

1999

Journal of Leukocyte Biology

177

125

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“…How ever the increase of endotoxin plasma levels in patients developing organ failure was less uniform than the loss of ENC. Regarding car diac surgery there is accumulating evidence that endotoxemia in fact does occur [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…The endotoxin determination of plasma samples has been described previously [22,28]. The same solutions arc used as described above.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

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Determination of Endotoxin-Neutralizing Capacity of Plasma in Postsurgical Patients

et al. 1996

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In 92 patients who underwent abdominal and goiter surgery endotoxin and endotoxin-neutralizing capacity (ENC) were determined in plasma preoperatively and daily postoperatively. Endotoxin plasma levels started to increase on day 1 in patients who were laparotomized. Correspondingly ENC was reduced during the 1st postoperative week. Even on the 1st postoperative day determination of ENC made the differentiation between patients possible who showed an uneventful course and patients who developed pneumonia, pulmonary failure, or mental disorders. Furthermore the need for diuretics in order to maintain sufficient renal function was associated with lower ENC during days 1–3. Endotoxin plasma levels were significantly elevated in patients who developed pneumonia during days 1–4, whereas the occurrence of pulmonary failure was only correlated with elevated endotoxin levels on day 3. Endotoxemia was pronounced in patients needing diuretics on days 1, 4, and 5. In patients who underwent goiter surgery ENC changed significantly as found for endotoxin plasma values during the postoperative course. Determination of endotoxin and especially ENC with the use of the limulus amebocyte lysate test turned out to be a reliable method correlating with impending complications at least in postsurgical patients.

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“…2,3 The kinetics of IL-6 following abdominal, cardiac, and orthopaedic surgery are well-understood. [4][5][6][7] In studies on the plasma levels of IL-1 and TNFa after surgery, however, incongruent results have been obtained. 6,8 The same holds true for the determination of these mediators during septic disease, with IL-6 probably representing a valuable prognostic parameter indicating septic complications.…”

Section: Introductionmentioning

confidence: 99%

Endotoxin-induced cytokine release from whole blood - similarities between monocyte dysfunction in septic disease and during postoperative acute phase response

Berger

Bölke

Seidelmann

et al. 1997

Journal of Endotoxin Research

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Plasma levels of endotoxin, TNFα, interleukin-1β (IL-1β), and interleukin-6 (IL-6) as well as the endotoxininduced release of these cytokines from whole blood were determined in 20 patients after elective aseptic surgery and eight patients suffering from septic disease. Blood samples were drawn before surgery as well as once daily over 7 days postoperatively. Endotoxin plasma levels increased on the day of the operation from 0.025 ± 0.005 EU/ml to 0.099 & p l u s m n ; 0.022 EU/ml and remained elevated for 1 day. No changes were noted in the plasma levels of TNFα and IL-1. Levels of IL-6 increased to 198 & p l u s m n ; 52 pg/ml on the day of the operation, while the release of TNFα and IL-6 markedly declined after whole blood was stimulated with endotoxin. The difference between basal and stimulated TNF values amounted to 505 & p l u s m n ; 129 pg/ml preoperatively and 132 & p l u s m n ; 41 pg/ml after the operation and 297 & p l u s m n ; 28 pg/ml and 137 & p l u s m n ; 43 pg/ml for IL-6. From the second day of the postoperative period onwards, the endotoxin-induced release of IL-6 was higher than the preoperative values. The results of whole blood stimulation in patients with sepsis were similar to those achieved directly after elective surgery. The cytokine release of TNFα, IL-1β, and IL-6 was reduced. We conclude that, during the early aseptic acute phase reaction, the changes in the functioning of monocytes resemble -qualitatively -those occurring during septic disease, and that this may be related to endotoxemia originating in the gastrointestinal tract.

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New aspects concerning the regulation of the postoperative acute phase reaction during cardiac surgery

Cited by 35 publications

References 43 publications

Neutrophil migration during endotoxemia

Neutrophil migration during endotoxemia

Determination of Endotoxin-Neutralizing Capacity of Plasma in Postsurgical Patients

Endotoxin-induced cytokine release from whole blood - similarities between monocyte dysfunction in septic disease and during postoperative acute phase response

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