A decreased serum concentration of nitrite/nitrate correlates with an increased plasma concentration of lactate during and after major surgery

Fujioka, Susumu; Mizumoto, Kiyoshi; Okada, Kazuo

doi:10.1007/s005950070036

Cited by 14 publications

(3 citation statements)

References 14 publications

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“…Reported results in these studies are inconsistent, with either no perioperative differences detected in MDA and NO (Ozmen et al 2002 , McHoney et al 2005 ) or increased MDA intraoperatively, with reductions in NO during surgery and up to day-1 thereafter (Zulfikaroglu et al 2002 , Bukan et al 2004 ). Data from investigations during major upper gastrointestinal surgery, however, found consistent reductions in NO production (Satoi et al 1998 , Fujioka et al 2000 ) supporting our findings. In addition to these, cGMP (a downstream messenger in the NO signalling pathway) was measured in our cohort, which showed a perioperative decline.…”

Section: Discussionsupporting

confidence: 90%

Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery

et al. 2023

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Background Tissue injury induces inflammation and the surgical stress response, which are thought to be central to the orchestration of recovery or deterioration after surgery. Enhanced formation of reactive oxygen and nitrogen species accompanies the inflammatory response and triggers separate but integrated reduction/oxidation (redox) pathways that lead to oxidative and/or nitrosative stress (ONS). Quantitative information on ONS in the perioperative period is scarce. This single-centre exploratory study investigated the effects of major surgery on ONS and systemic redox status and their potential associations with postoperative morbidity. Methods Blood was collected from 56 patients at baseline, end of surgery (EoS) and the first postoperative day (day-1). Postoperative morbidity was recorded using the Clavien-Dindo classification and further categorised into minor, moderate and severe. Plasma/serum measures included markers of lipid oxidation (thiobarbituric acid-reactive substances; TBARS, 4-hydroxynonenal; 4-HNE, 8-iso-prostaglandin F2⍺; 8-isoprostanes). Total reducing capacity was measured using total free thiols (TFTs) and ferric-reducing ability of plasma (FRAP). Nitric oxide (NO) formation/metabolism was measured using cyclic guanosine monophosphate (cGMP), nitrite, nitrate and total nitroso-species (RxNO). Interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-⍺) were measured to evaluate inflammation. Results Both oxidative stress (TBARS) and nitrosative stress (total nitroso-species) increased from baseline to EoS (+14%, P = 0.003 and +138%, P < 0.001, respectively), along with an increase in overall reducing capacity (+9%, P = 0.03) at EoS and protein-adjusted total free thiols (+12%, P = 0.001) at day-1 after surgery. Nitrite, nitrate and cGMP concentrations declined concomitantly from baseline to day-1. Baseline nitrate was 60% higher in the minor morbidity group compared to severe (P = 0.003). The increase in intraoperative TBARS was greater in severe compared to minor morbidity (P = 0.01). The decline in intraoperative nitrate was more marked in the minor morbidity group compared to severe (P < 0.001), whereas the cGMP decline was greatest in the severe morbidity group (P = 0.006). Conclusion In patients undergoing major HPB surgery, intraoperative oxidative and nitrosative stress increased, with a concomitant increase in reductive capacity. Baseline nitrate was inversely associated with postoperative morbidity, and the hallmarks of poor postoperative outcome include changes in both oxidative stress and NO metabolism.

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Section: Discussionsupporting

confidence: 90%

Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery

et al. 2023

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“…A small number of previous studies have investigated NO Bukan et al, 2004). Data from investigations during major upper gastrointestinal surgery however, found consistent reductions in NO production (Satoi et al, 1998, Fujioka et al, 2000 supporting our ndings. In addition to these, cGMP (a downstream messenger in the NO signalling pathway) was measured in our cohort, which showed a perioperative decline.…”

Section: Discussionsupporting

confidence: 88%

Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery

Stevens

McKenna

BSc

et al. 2023

Preprint

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Background Tissue injury induces inflammation and the surgical stress response, which are thought to be central to the orchestration of recovery or deterioration after surgery. Enhanced formation of reactive oxygen and nitrogen species accompanies the inflammatory response and triggers separate but integrated reduction/oxidation (redox) pathways that leads to oxidative and/or nitrosative stress (ONS). Quantitative information on ONS in the perioperative period is scarce. This single-centre exploratory study investigated the effects of major surgery on ONS and systemic redox status, and their potential associations with postoperative morbidity. Methods Blood was collected from 56 patients at baseline, end of surgery (EoS), and on day-1. Postoperative morbidity was recorded using the Clavien-Dindo classification and further categorised into minor, moderate and severe. Plasma/serum measures included markers of lipid oxidation (thiobarbituric acid-reactive substances; TBARS, 4-hydroxynonenal; 4-HNE, 8-iso-prostaglandin F2⍺; 8-isoprostanes). Total reducing capacity was measured using total free thiols (TFTs) and ferric reducing ability of plasma (FRAP). Nitric oxide (NO) formation/metabolism, was measured using cyclic guanosine monophosphate (cGMP), nitrite, nitrate and total nitroso-species (RxNO). Interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-⍺) were measured to evaluate inflammation. Results Both oxidative stress (TBARS) and nitrosative stress (total nitroso-species) increased from baseline to EoS (+ 14%, P = 0.003 and + 138%, P < 0.001 respectively), along with an increase in overall reducing capacity (+ 9%, P = 0.03) at EoS and protein-adjusted total free thiols (+ 12%, P = 0.001) day-1 after surgery. Nitrite, nitrate and cGMP concentrations declined concomitantly from baseline to day-1. Baseline nitrate was 60% higher in the minor morbidity group compared to severe (P = 0.003).The increase in intraoperative TBARS was greater in severe compared to minor morbidity (P = 0.01). The decline in intraoperative nitrate was more marked in the minor morbidity group compared to severe (P < 0.001), whereas the cGMP decline was greatest in the severe morbidity group (P = 0.006). Conclusion In patients undergoing major HPB surgery, intraoperative oxidative and nitrosative stress increased, whilst reductive capacity also increased. Baseline nitrate was inversely associated with postoperative morbidity, and the hallmarks of poor postoperative outcome include changes in both oxidative stress and NO metabolism.

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“… 11 evaluated NO metabolism following major elective surgery, and demonstrated that plasma nitrate and nitrite levels had a biphasic response in which they decreased early after surgery and normalized by POD 7. Decreased circulating nitrate and nitrite levels have also been observed early after thoracoabdominal 12 or hepato‐pancreato‐biliary surgery 13 . Contradictory to these observations, Arias‐Diaz et al.…”

Section: Discussionmentioning

confidence: 98%

Enteral immuno-enhanced diets with arginine are safe and beneficial for patients early after esophageal cancer surgery

Aiko

Yoshizumi

Ishizuka

et al. 2008

Diseases of the Esophagus

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We previously reported that provision of immediate enteral nutrition (EN) with a certain amount of omega (omega)-3 fatty acids (FAs) in patients after esophageal cancer surgery resulted in reduced platelet aggregation, coagulation activity, and cytokine production. We investigated whether EN using immuno-enhanced diet (IED) containing a large amount of omega-3 FAs as well as arginine and RNA affected the above-described responses. We also attempted to reveal whether arginine in the IED can potentially harm patients who undergo esophageal cancer surgery. Twenty-nine patients with esophageal cancer who underwent similar surgical procedures were selected. All patients received EN starting immediately after surgery. Fourteen patients received the formula with fewer omega-3 FAs, and fifteen patients received the IED. Administration of the IED tended to inhibit postoperative decrease in platelet count. Prothrombin activity and thrombin-antithrombin III complex levels were significantly reduced in the IED group. Plasma IL-8 levels were significantly lower (P < 0.05) in patients without the IED on the fifth postoperative day (POD). The proportion of T-cells was significantly higher (P < 0.05) in the IED group on PODs 1 and 7. Nitrate/nitrite levels did not differ significantly between the two groups. Early EN with an IED may enhance the inhibitory effects on postoperative platelet aggregation and hypercoagulation, and appeared to be advantageous to T-cell proliferation. These effects are expected to be beneficial in patients at risk of developing infectious complications. This study also showed that the IED could be safely used without any adverse effects for patients early after a radical surgery for the esophageal cancer.

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A decreased serum concentration of nitrite/nitrate correlates with an increased plasma concentration of lactate during and after major surgery

Cited by 14 publications

References 14 publications

Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery

Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery

Perioperative redox changes in patients undergoing hepato-pancreatico-biliary cancer surgery

Enteral immuno-enhanced diets with arginine are safe and beneficial for patients early after esophageal cancer surgery

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