The evidence of oxidative stress in cardiac surgery and septic patients: A comparative study

Starkopf, Joel; Tamme, Kadri; Zilmer, Mihkel; Talvik, R.; Samarütel, J.

doi:10.1016/s0009-8981(97)06540-6

Cited by 28 publications

(18 citation statements)

References 29 publications

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“…Major surgery is known to cause an increase in reactive oxygen species (ROS) production, and hence the onset of oxidative stress (OS) [15,[35][36][37][38][39]. The occurrence of oxidative stress in aortic aneurysm repair specifically has been recently reviewed [40].…”

Section: Resultsmentioning

confidence: 99%

Metabolic Profiling of Patients Undergoing Elective Aortic Aneurysm Repair Surgery: Correlation with Anaerobic Threshold

McRae

Howard

Homer-Vanniasinkam

et al. 2012

ISRN Vascular Medicine

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The anaerobic threshold (AT) measured by the cardiopulmonary exercise (CPX) test is becoming an established means of identifying patients at high risk of developing cardiac complications perioperatively. The aim of the present study was to investigate the relationship between AT and the plasma metabolic profile of patients undergoing aortic aneurysm repair surgery to see if an alternative or adjunct to the CPX test could be devised. Plasma was obtained from 15 male patients classified (through preoperative CPX tests) as having high (≥11.0 mL kg −1 min −1 ) or low (<11.0 mL kg −1 min −1 ) AT before and 1, 2, 24, 48, and 72 hours after elective open aortic aneurysm surgery. Samples were analysed using 1 H-NMR spectroscopy coupled with multivariate statistical analysis. Principal components analysis (PCA) and partial least squares discriminant analysis (PLS-DA) distinguished between low-and high-AT patients postoperatively, with high AT patients being more tightly clustered. High AT patients had higher plasma lipid and lower 3-hydroxybutyrate and acetoacetate levels than low AT patients post-operatively. Similar differences were identified preoperatively. 1 H-NMR metabolic profiling of plasma has identified molecules whose concentration correlates with AT scores. These may prove a useful biomarker in conjunction with AT in predicting response to major surgical procedures.

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Section: Resultsmentioning

confidence: 99%

Metabolic Profiling of Patients Undergoing Elective Aortic Aneurysm Repair Surgery: Correlation with Anaerobic Threshold

McRae

Howard

Homer-Vanniasinkam

et al. 2012

ISRN Vascular Medicine

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“…This technique is aggressive and the patients are subjected to a high degree of organ injury [1][2][3][4]. Many previous studies have focused on organ protection after CPB, but most of them only involve organs such as heart, lung, and kidney.…”

Section: Introductionmentioning

confidence: 99%

“…Liver damage after cardiac surgery with CPB is caused by two related pathophysiological mechanisms: the systemic inflammatory response syndrome (SIRS) and oxidative stress [3][4][5][6][7]. During the extracorporeal circuit, SIRS is triggered by the exposure of blood to the unphysiological hemodynamic conditions.…”

Section: Introductionmentioning

confidence: 99%

Protective Effects of Melatonin and N-Acetylcysteine on Hepatic Injury in a Rat Cardiopulmonary Bypass Model

Huang

Yin

Zhu

et al. 2007

Journal of Surgical Research

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“…31,175 These reactive species create an environment of oxidative stress, which have been shown to contribute to myocardial depression, cardiac arrhythmias, pulmonary dysfunction and acute kidney injury. 4 The oxidative stress response is mitigated by an appropriate antioxidant response.…”

Section: Rationalementioning

confidence: 99%

“…13,29 Concurrently there are also increases in oxidative stress, 175 although these alterations have largely been identified in separate studies to that of selenium investigations. That oxidative stress and inflammation are important components to the development of POAF, and the realization that many cardiac patients present to surgery with suboptimal selenium levels, lends itself to the hypothesis that low pre-operative selenium levels may increase the risk of POAF in those patients who had other risk factors favoring the development of POAF such as proposed in Figure 2-6.…”

mentioning

confidence: 99%

Selenium and oxidative stress modulation during extracorporeal circulation

McDonald¹

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Oxidative stress occurs when there is an imbalance between reactive oxygen and nitrogen species (RNOS) and the antioxidant system. In cardiac surgery patients and the critically ill there is an association between oxidative stress and morbidity and mortality.Extracorporeal circulation (ECC) encompasses cardiopulmonary bypass (CPB) which is used for cardiac surgery; extracorporeal membrane oxygenation (ECMO) which is used for cardio-respiratory support in the critically ill and haemodialysis which is used in patients with intermittent or end-stage renal failure.During ECC, the patient's total blood volume is in direct contact with an artificial surface for extended periods. In addition, there is often pre-existing inflammation, surgical trauma and/or ischemia-reperfusion (I-R) injury, all of which are major activators for the increased production of RNOS. Concurrent decreases in the level of essential antioxidants and trace elements (such as selenium, zinc and copper) occur, which upset redox balance in favour of oxidative stress. The trace element selenium is required for the normal function of the antioxidant enzyme glutathione peroxidase (GPx). Despite in vitro and biochemical data suggesting that reinforcement of antioxidant activity by selenium supplementation might reduce excessive oxidative stress damage, there is conflicting evidence in clinical studies.The reason for failure of antioxidant supplementation in the clinical setting is currently unclear.We postulated that the ECC and its associated interventions such as transfusion, might have a larger impact on trace element loss, antioxidant function and the oxidative stress response than previously recognised. This led to the following questions:  What is the selenium level in healthy Queensland residents, and is this level similar to that reported in other parts of the world? Does a patient's pre-CPB or pre-ECMO circulating selenium level influence their outcome? Does the ECC independently alter circulating selenium levels and the oxidative stress response? Do other interventions during ECC, such as transfusion, alter circulating selenium and oxidative stress levels?iii This thesis focussed on oxidative stress and the trace element selenium, because oxidative stress is associated with poorer outcomes in cardiac and critically ill patients, and decreased selenium is independently associated with poorer outcomes. To answer the research questions outlined above, a series of experiments were designed and conducted, and they generated the following new information.The average selenium level in a Queensland blood donor population was defined at 1.09 µmol/L (Chapter 3). In addition 88.5% of participants had a selenium level lower than the critical level required for maximal glutathione peroxidase activity, which has previously been determined to be between 1.14 -1.27 µmol/L. Furthermore, this study generated novel information that packed red blood cells and buffy coat pooled platelets have very low levels of selenium (≤ 0.3 µmol/L).The effect of car...

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The evidence of oxidative stress in cardiac surgery and septic patients: A comparative study

Cited by 28 publications

References 29 publications

Metabolic Profiling of Patients Undergoing Elective Aortic Aneurysm Repair Surgery: Correlation with Anaerobic Threshold

Metabolic Profiling of Patients Undergoing Elective Aortic Aneurysm Repair Surgery: Correlation with Anaerobic Threshold

Protective Effects of Melatonin and N-Acetylcysteine on Hepatic Injury in a Rat Cardiopulmonary Bypass Model

Selenium and oxidative stress modulation during extracorporeal circulation

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