Remifentanil increases the incidence of mesenteric traction syndrome: preliminary randomized controlled trial

Nomura, Yuki; Funai, Yusuke; Fujimoto, Yohei; Hori, Naoto; Hirakawa, K; Hotta, Arisa; Nakamoto, Ai; Yoshikawa, Noriko; Ohira, Naoko; Tatekawa, Shigeki

doi:10.1007/s00540-010-0998-y

Cited by 22 publications

(8 citation statements)

References 17 publications

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“…Epidural anesthesia reduces SVR [ 26 ] due to sympatholysis as observed in the OE-group while SVR remained stable in the RE-group, besides a transitory increase may be due to CO 2 insufflation with release of hormones like noradrenalin, compression of the splanchnic organs, and CO 2 absorbed from the peritoneal cavity [ 27 , 28 ]. Moreover, traction of the viscera can stimulate release of vasoactive hormones like prostacyclin corroborating a decrease in SVR, more prevalent during open than laparoscopic surgery [ 29 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

et al. 2017

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BackgroundIt remains debated how much fluid should be administered during surgery. The atrial natriuretic peptide precursor proANP is released by atrial distension and deviations in plasma proANP are reported associated with perioperative fluid balance. We hypothesized that plasma proANP would decrease when the central blood volume is compromised during the abdominal part of robot-assisted hybrid (RE) esophagectomy and that a positive fluid balance would be required to maintain plasma proANP.MethodsPatients undergoing RE (n = 25) or open (OE; n = 25) esophagectomy for gastroesophageal cancer were included consecutively in this prospective observational study. Plasma proANP was determined repetitively during esophagectomy to allow for distinction between the abdominal and thoracic part of the procedure. The RE group was 15° head up tilted during the abdominal procedure.ResultsThe blood loss was 250 (150–375) (RE) and 600 ml (390–855) (OE) (p = 0.01), but the two groups of patients were provided with a similar positive fluid balance: 1705 (1390–1983) vs. 1528 ml (1316–1834) (p = 0.4). However, plasma proANP decreased by 21% (p < 0.01) during the abdominal part of RE carried out during moderate head-up tilt, but only by 11% (p = 0.01) during OE where the patients were supine. Plasma proANP and fluid balance were correlated in the RE-group (r = 0.5 (0.073–0.840), p = 0.02) and tended to correlate in the OE group (r = 0.4 (−0.045–0.833), p = 0.08).ConclusionThe results support that plasma proANP decreases when the central blood volume is compromised and suggest that an about 2200 ml surplus administration of crystalloid is required to maintain plasma proANP during esophagectomy.Trial registrationClinicaltrials.gov (NCT02077673). Registered retrospectively February 12th 2014.

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Section: Discussionmentioning

confidence: 99%

Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

et al. 2017

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“…Plasma PGF-1 levels were measured prior to surgery and 20 minutes following skin incision. The study found that 40% of the patients receiving remifentanil developed MTS, while only 10% of patient's in the fentanyl group developed MTS [11]. Previous studies have shown the mechanism of action of remifentanil's vasodilation is likely due to enhanced secretion of nitric oxide and prostacyclin from endothelial cells [12].…”

Section: Prevention Of Mesenteric Traction Syndromementioning

confidence: 92%

“…In 2010, Y Nomura et al [11] published a study demonstrating that remifentanil infusions increased the likelihood of development of mesenteric traction syndrome. This study included 100 patients undergoing laparoscopic and open abdominal surgeries.…”

Section: Prevention Of Mesenteric Traction Syndromementioning

confidence: 99%

What Anesthesiologists Need to Know About Mesenteric Traction Syndrome

2017

JACCOA

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The first time I heard of mesenteric traction syndrome was three years into my training as an anesthesia resident. This first time was unfortunately intraoperatively while my patient was acutely unstable and mesenteric traction syndrome was part of my anesthesia team's differential diagnosis. Following this event I set out to educate myself about mesenteric traction syndrome and was shocked to find there was very little mention of it in the anesthesia literature, especially common textbooks that I had used throughout my residency to educate myself. The goal of this article is to present the literature on mesenteric traction that I encountered during my research and to provide a thorough review of the consensus on the etiology, pathophysiology, prevention and treatment of mesenteric traction syndrome. At the end of the review, I examine areas of mesenteric traction that need further investigation in order to fully understand mesenteric traction syndrome and what we can do, as anesthesiologists, to prevent it and appropriately treat it.

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“…To confirm the synthesis of prostacyclin, which triggers MTS, we measured the levels of 6-keto-PGF1α, a stable metabolite of prostacyclin. Because a previous report described the mean onset time of MTS to be 16 ± 5 min after skin incision with symptoms persisting over approximately 30 min [ 16 ], blood was collected from an arterial line at the initiation of surgery (T0) as well as at 15, 30, and 60 min after the initiation of surgery (T15, T30, and T60, respectively). The samples were refrigerated and centrifugal separation was rapidly performed.…”

Section: Methodsmentioning

confidence: 99%

Therapeutic effects of flurbiprofen axetil on mesenteric traction syndrome: randomized clinical trial

Takahashi¹,

Shida²,

Tagawa³

et al. 2017

BMC Surg

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BackgroundThis study aimed to reveal the appropriate timing for the intravenous administration of flurbiprofen axetil for preventing mesenteric traction syndrome (MTS), caused by prostacyclin release.MethodsIn this prospective, randomized, clinical study, forty-five patients who were undergoing elective surgery for colorectal cancer via laparotomy were enrolled. Patients were randomly divided into 3 groups: a preoperative group (n = 16) receiving flurbiprofen axetil directly before surgery; a post-MTS group (n = 14) receiving following MTS onset; and a control group (n = 15) who were not administered flurbiprofen axetil. 6-keto-PGF1α, a stable metabolite of prostacyclin, levels were measured and mean blood pressures were recorded.ResultsIn the preoperative group, 6-keto-PGF1α levels did not increase, blood pressure levels did not decrease, and no facial flushing was observed. In both the post-MTS and control groups, 6-keto-PGF1α levels increased markedly after mesenteric traction and blood pressure decreased significantly. The post-MTS group exhibited a faster decreasing trend in 6-keto-PGF1α levels and quick restore of the mean blood pressure, and the use of vasopressors and phenylephrine were lower than that in the control group.ConclusionsEven therapeutic administration of flurbiprofen axetil after the onset of MTS has also effects on MTS by suppressing prostacyclin production.Trial registrationClinical trial number: UMIN000009111. (Registered 14 October 2012)

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Remifentanil increases the incidence of mesenteric traction syndrome: preliminary randomized controlled trial

Abstract: The results of this study suggest that the use of remifentanil in laparotomy facilitates MTS.

Cited by 22 publications

References 17 publications

Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

What Anesthesiologists Need to Know About Mesenteric Traction Syndrome

Therapeutic effects of flurbiprofen axetil on mesenteric traction syndrome: randomized clinical trial

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