Neurodystrophic component of pathogenesis of the acute postoperative pancreatitis and its prevention by epidural anesthesia

Abstract

The data on the etiology and pathogenesis of acute postoperative pancreatitis (APP) are analyzed. It is noted that in its pathogenesis, currently, the main attention is paid to the factors of aggression in the pancreas: the activation of proteolytic enzymes and autocatalytic reactions leading to damage of the acinous cells, microcirculation disturbance, and enhancement of free radical oxidation. This determines the prevention and treatment of acute postoperative pancreatitis with the use the inhibition of protease and exocrine secretion of pancreas, antioxidants and cytostatics. Biochemical mechanisms of resistance of the pancreas tissue to damage are given much less attention. The authors substantiate the proposition that organ tissue resistance, besides adequate microcirculation and oxygenation, is determined by the mechanisms of nerve tropism mediated through the sympathetic nervous system. Experimental and clinical data are presented that irritation of the reflexogenic pyloroduodenal zone, in particular during operations in conditions of inadequate anesthesia, leads to hyper activation of the sympathetic nervous system, increased release of the noradrenaline, subsequent depletion of its content in the pancreas tissues. Therefore adrenergic support of trophic (energy and plastic processes) in the pancreas is disrupted, contributing to the development of postoperative complications, including acute postoperative pancreatitis. Taking into account that epidural anesthesia performs afferent and efferent, including sympathetic, blockades; the substantiations are given for use epidural anesthesia for acute postoperative pancreatitis prevention in abdominal operations in combination with the components of general anesthesia.

On the history of the study of the nervous trophism mechanisms, disorders, and correction in the Institute of Experimental Medicine (100^th anniversary of the S.V. Anichkov Department of Pharmacology)

“…Защитные эффекты симпатолитиков (гуанетидин, бретилий) и препаратов, обладающих симпатолитическим компонентом действия (клонидин, гексаметония бромид, гексаметония бензосульфонат) в отношении развития рефлекторной дистрофии миокарда, желудка, печени и поджелудочной железы, хорошо согласуются с многочисленными клиническими данными о предупреждении с помощью обладающих симпатолитическим действием эпидуральной и спинальной анестезии интраоперационных нарушений и послеоперационных осложнений [22][23][24]59]. В частности, такой способностью обладает разработанная В.И.…”