Prevenção de aderências pericárdicas pós-operatórias com uso de carboximetilquitosana termoestéril

Abstract

Objective: The aim of this study is to evaluate CMC physicalchemical alterations after thermal sterilization and its efficacy in preventing poststernotomy pericardial adhesions.Methods: After autoclaving thermal sterilization, thermal sterile Carboxymethyl Chitosan (CMCts) was submitted to physical-chemical analysis. Twelve animals were divided into two groups and underwent pericardiotomy and adhesion induction protocol. Afterward, topic CMCts or saline solution was administered. After 8 weeks, a sternotomy was performed for adhesion score macroscopic evaluation, dissection time and the amount of recalcitrant dissection, and microscopic evaluation.Results: Physical-chemical analysis showed no difference between CMC and CMCts. A macroscopic analysis showed that the intensity of adhesions was significantly lower in the CMCts group (P=0.007). Dissection time and use of recalcitrant dissection also decreased significantly (P=0.007, P=0.008; respectively). Microscopic results indicated a significant reduction in the epicardium collagen area and in the total epicardium area (P=0.05) and (P=0.03). Conclusion ResumoObjetivo: Este trabalho tem como objetivo avaliar alterações físico-químicas da carboximetilquitosana após termoesterilização e sua eficácia na prevenção de aderências pericárdicas pós-esternotomia.Métodos: Após ser submetida a termoesterilização em autoclave, a carboximetilquitosana termoestéril (CMQte) foi submetida a análises físico-químicas. Doze animais foram divididos em dois grupos e submetidos à pericardiotomia e a protocolo de indução de aderências. A seguir, foi aplicada de forma tópica a CMQte ou solução 6. Titular Professor of the Discipline

Fechamento primário do pericárdio em cirurgia cardíaca: uma opção segura?

“…Despite the quality of these studies, we used canines or swines that were not undergoing cardiopulmonary bypass, thus had no intense systemic inflammatory reaction, less bleeding and reintervention performed in a period that does not correspond to the interventions in clinical practice. The authors report that the adhesions formed were so strong or even stronger than those observed without the presence of biological or synthetic material [11][12][13][14][15][16][17][18].…”

“…Among the most relevant is the primary closure of the pericardium with interrupted continuous stitches with Vicryl ® 2-0 [9], the use of synthetic fabrics, using screen PTFE [10] and membranes of bio-absorbable materials or autologous pericardium [11] with the aim of reducing the reactions that culminate in the formation of adhesions. Recently, Daroz et al [12] suggested in an article published in the Brazilian Journal of Cardiovascular Surgery, the use of CMC as an agent for preventing adhesions following sternotomy.…”

Cloreto de sódio a 0,9%, adicionado ou não de dexametasona, intrapleural, na prevenção de aderências pulmonares após toracotomia intercostal em cães

“…As aderências foram classifi cadas, de acordo com DAROZ et al (2008). Amostras das aderências (9x3x2mm) foram colhidas com a pinça saca-bocado e mantidas em formalina tamponada a 10%, enviadas para processamento.…”

“…JERICÓ (2008) indica a dexametasona na dose de 1,0mg kg -1 como anti-infl amatório em paciente de trauma. DAROZ et al (2008) estudaram aderências pericárdicas e classifi caram-nas em: escore 0 -ausentes; escore I -frouxas, facilmente dissecáveis e que se desfazem com facilidade à dissecação romba; escore II -intermediárias, desfeitas com dissecção romba mais agressiva ou com utilização de pouca dissecção cortante; têm um plano identifi cável entre as superfícies e resulta em sangramento moderado; escore III -fi rmes: só se desfazem com dissecção cortante; não têm um plano bem defi nido entre as superfícies e sangram facilmente.…”

A novel silkworm pupae carboxymethyl chitosan inhibits mouse L929 fibroblast proliferation

“…Fibroblast cell inhibition would play a great role in preventing postoperative adhesions in biomedical applications. Many experiments have shown that carboxymethyl chitosan prevents adhesion by inhibiting fibroblast proliferation in many animal models during surgery, such as abdominal operations [15], cardiac surgery [16,17], and cardiovascular reoperations [18,19].…”