ascorbic-acid and Postoperative-Complications

Perioperative oxidative stress plays a role in organ injury and pain and could be improved by the antioxidant effects of vitamin C.. We performed a systematic review and meta-analysis of RCTs comparing perioperative vitamin C administration vs placebo or no treatment in adults undergoing noncardiac surgery. The primary outcome was hospital length of stay (LOS).. Thirty-seven RCTs and 2747 patients were included. Administration of vitamin C was associated with no difference in LOS (mean difference=0.02 day; 95% confidence interval [CI], -0.30 to 0.35; P=0.88). Mortality did not differ between groups (relative risk=1.04; 95% CI, 0.52 to 2.08; P=0.5). No trials reported on other major postoperative complications. Vitamin C was associated with a reduction in postoperative pain score and cumulative morphine consumption up to 48 h after surgery. The incidence of complex regional pain syndrome was lower in orthopaedic patients receiving vitamin C. Adverse events were present in three RCTs (n=157), absent in 10 RCTs (n=957), and not reported in 25 RCTs (n=1570). One trial (n=20) in kidney transplantation surgery was stopped early because of safety concerns on vitamin C. The quality of evidence ranged from moderate to very low.. Administration of vitamin C was not associated with a decrease in LOS after noncardiac surgery. The effects on morbidity and mortality are inconclusive and mostly uninvestigated. A small reduction in postoperative pain was found. Adverse events were rare but not systematically assessed. The evidence is uncertain, not supporting the use of vitamin C outside an experimental setting.. PROSPERO database, CRD42021241654.

Topics: Adult; Ascorbic Acid; Humans; Length of Stay; Morphine; Pain, Postoperative; Postoperative Complications; Randomized Controlled Trials as Topic

The definition of sepsis continues to be as dynamic as the management strategies used to treat this. Sepsis-3 has replaced the earlier systemic inflammatory response syndrome (SIRS)-based diagnoses with the rapid Sequential Organ Failure Assessment (SOFA) score assisting in predicting overall prognosis with regards to mortality. Surgeons have an important role in ensuring adequate source control while recognizing the threat of carbapenem-resistance in gram-negative organisms. Rapid diagnostic tests are being used increasingly for the early identification of multi-drug-resistant organisms (MDROs), with a key emphasis on the multidisciplinary alert of results. Novel, higher generation antibiotic agents have been developed for resistance in ESKCAPE (

Topics: Acinetobacter baumannii; Acinetobacter Infections; Angiotensin II; Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Carbapenem-Resistant Enterobacteriaceae; Drug Resistance, Multiple, Bacterial; Duration of Therapy; Enterobacteriaceae Infections; Enterococcus faecium; Enzyme Inhibitors; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Machine Learning; Methicillin-Resistant Staphylococcus aureus; Methylene Blue; Organ Dysfunction Scores; Patient Care Bundles; Postoperative Complications; Practice Guidelines as Topic; Procalcitonin; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Shock, Septic; Staphylococcal Infections; Thiamine; Vancomycin-Resistant Enterococci; Vasoconstrictor Agents; Vitamin B Complex

The effects of vitamin C administration on clinical outcome in critically ill patients remain controversial.. Online databases were searched up to October 1, 2018.. We included randomized controlled trials on the use of vitamin C (any regimen) in adult critically ill patients versus placebo or no therapy.. Risk ratio for dichotomous outcome and standardized mean difference for continuous outcome with 95% CI were calculated using random-effects model meta-analysis.. Forty-four randomized studies, 16 performed in ICU setting (2,857 patients) and 28 in cardiac surgery (3,598 patients), published between 1995 and 2018, were included in the analysis. In ICU patients, vitamin C administration was not associated with a difference in mortality (risk ratio, 0.90; 95% CI, 0.74-1.10; p = 0.31), acute kidney injury, ICU or hospital length of stay compared with control. In cardiac surgery, vitamin C was associated to a reduction in postoperative atrial fibrillation (risk ratio, 0.64; 95% CI, 0.52-0.78; p < 0.0001), ICU stay (standardized mean difference, -0.28 d; 95% CI, -0.43 to -0.13 d; p = 0.0003), and hospital stay (standardized mean difference, -0.30 d; 95% CI, -0.49 to -0.10 d; p = 0.002). Furthermore, no differences in postoperative mortality, acute kidney injury, stroke, and ventricular arrhythmia were found.. In a mixed population of ICU patients, vitamin C administration is associated with no significant effect on survival, length of ICU or hospital stay. In cardiac surgery, beneficial effects on postoperative atrial fibrillation, ICU or hospital length of stay remain unclear. However, the quality and quantity of evidence is still insufficient to draw firm conclusions, not supporting neither discouraging the systematic administration of vitamin C in these populations. Vitamin C remains an attractive intervention for future investigations aimed to improve clinical outcome.

Topics: Acute Kidney Injury; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Cardiac Surgical Procedures; Critical Illness; Humans; Intensive Care Units; Length of Stay; Postoperative Complications; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome

The pleiotropic biochemical and antioxidant functions of vitamin C have sparked recent interest in its application in intensive care. Vitamin C protects important organ systems (cardiovascular, neurologic and renal systems) during inflammation and oxidative stress. It also influences coagulation and inflammation; its application might prevent organ damage. The current evidence of vitamin C's effect on pathophysiological reactions during various acute stress events (such as sepsis, shock, trauma, burn and ischemia-reperfusion injury) questions whether the application of vitamin C might be especially beneficial for cardiac surgery patients who are routinely exposed to ischemia/reperfusion and subsequent inflammation, systematically affecting different organ systems. This review covers current knowledge about the role of vitamin C in cardiac surgery patients with focus on its influence on organ dysfunctions. The relationships between vitamin C and clinical health outcomes are reviewed with special emphasis on its application in cardiac surgery. Additionally, this review pragmatically discusses evidence on the administration of vitamin C in every day clinical practice, tackling the issues of safety, monitoring, dosage, and appropriate application strategy.

Topics: Antioxidants; Ascorbic Acid; Cardiac Surgical Procedures; Cardiovascular System; Critical Care; Humans; Kidney; Multiple Organ Failure; Nervous System; Oxidative Stress; Postoperative Complications; Vitamins

Atrial fibrillation (AF), a common arrhythmia contributing substantially to cardiac morbidity, is associated with oxidative stress and, being an antioxidant, vitamin C might influence it.. We searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for randomised trials on vitamin C that measured AF as an outcome in high risk patients. The two authors independently assessed the trials for inclusion, assessed the risk of bias, and extracted data. We pooled selected trials using the Mantel-Haenszel method for the risk ratio (RR) and the inverse variance weighting for the effects on continuous outcomes.. We identified 15 trials about preventing AF in high-risk patients, with 2050 subjects. Fourteen trials examined post-operative AF (POAF) in cardiac surgery patients and one examined the recurrence of AF in cardioversion patients. Five trials were carried out in the USA, five in Iran, three in Greece, one in Slovenia and one in Russia. There was significant heterogeneity in the effect of vitamin C in preventing AF. In 5 trials carried out in the USA, vitamin C did not prevent POAF with RR = 1.04 (95% CI: 0.86-1.27). In nine POAF trials conducted outside of the USA, vitamin C decreased its incidence with RR = 0.56 (95% CI: 0.47-0.67). In the single cardioversion trial carried out in Greece, vitamin C decreased the risk of AF recurrence by RR = 0.13 (95% CI: 0.02-0.92). In the non-US cardiac surgery trials, vitamin C decreased the length of hospital stay by 12.6% (95% CI 8.4-16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI 3.0-13.0%). The US trials found no effect on hospital stay and ICU stay. No adverse effects from vitamin C were reported in the 15 trials.. Our meta-analysis indicates that vitamin C may prevent post-operative atrial fibrillation in some countries outside of the USA, and it may also shorten the duration of hospital stay and ICU stay of cardiac surgery patients. Vitamin C is an essential nutrient that is safe and inexpensive. Further research is needed to determine the optimal dosage protocol and to identify the patient groups that benefit the most.

Topics: Aged; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Chi-Square Distribution; Female; Humans; Incidence; Length of Stay; Male; Middle Aged; Odds Ratio; Oxidative Stress; Postoperative Complications; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Time Factors; Treatment Outcome

Results of a systematic review and meta-analysis of published data on use of ascorbic acid to prevent postoperative atrial fibrillation (POAF) after cardiac surgery are presented.. MEDLINE and other sources were searched for reports on trials evaluating the effects of preoperative and/or postoperative use of ascorbic acid in patients undergoing cardiac surgery. For each study selected for meta-analysis, an assessment for risks of methodological bias was performed. Data on POAF frequency and length of stay (LOS) outcomes were pooled and analyzed via random-effects modeling.. The 11 identified studies involved patients receiving coronary artery bypass grafts with or without valve replacement; both i.v. and oral ascorbic acid formulations were used. Analysis of pooled outcomes data on treatment and control groups indicated that ascorbic acid prophylaxis was associated with reductions in POAF frequency (odds ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61), intensive care unit (ICU) LOS (difference in means, -0.24 day; 95% CI, -0.45 to -0.03 day), and total hospital LOS (difference in means, -0.94 day; 95% CI, -1.65 to -0.23 day). Significant statistical, methodological, and clinical heterogeneity were observed.. A meta-analysis revealed that, compared with use of a placebo or a nonplacebo control, perioperative administration of ascorbic acid to patients undergoing cardiac surgery was associated with a reduced frequency of POAF and a shorter ICU LOS and total hospital LOS.

Topics: Anti-Arrhythmia Agents; Ascorbic Acid; Atrial Fibrillation; Cardiac Surgical Procedures; Humans; Postoperative Complications; Randomized Controlled Trials as Topic

Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions.

Topics: Adrenal Cortex Hormones; Ascorbic Acid; Atrial Fibrillation; Cardiac Surgical Procedures; Colchicine; Fatty Acids, Omega-3; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Inflammation; Inflammation Mediators; Myocardial Reperfusion Injury; Oxidative Stress; Postoperative Complications; Reactive Oxygen Species; Risk Factors; Systemic Inflammatory Response Syndrome; Vitamin E

The effects of omega-3 polyunsaturated fatty acids (PUFA) on the prevention of postoperative atrial fibrillation (POAF) are inconclusive in current studies. Moreover, the most appropriate composition of PUFA to play the protective role is unclear. The aim of this meta-analysis was to ascertain the protective role of PUFA on POAF and the most appropriate composition.. Studies were identified through PubMed, CENTRAL, EMBASE, reviews and reference lists of relevant papers. The odds ratio (OR) was calculated for POAF. Statistical analyses were performed with Review Manager 5.0.. Eleven randomised controlled trials with 3137 patients were included in the analysis. The use of PUFA alone did not reduce the incidence of POAF compared with the control (OR: 0.76; 95% confidence interval [CI]: 0.57-1.03; P=0.08; I(2)=52%). However, combination therapy with PUFA and vitamins C and E reduced the incidence of POAF by 68% (OR: 0.32; 95%CI: 0.17-0.60; P=0.0005; I(2)=38%). Subgroup analysis indicated that the ratio of EPA/DHA 1:2 was effective in preventing POAF (OR: 0.35; 95%CI: 0.24-0.50; P<0.00001; I(2)=0%), while the ratio not 1:2 failed.. Combination therapy with PUFA and vitamins C and E is effective in the prevention of POAF while PUFA alone is not. The ratio of EPA/DHA may influence the incidence of POAF, and 1:2 may be most appropriate. Studies about PUFA on the prevention of POAF are still worthwhile to be conducted in the future.

Topics: Antioxidants; Ascorbic Acid; Atrial Fibrillation; Cardiac Surgical Procedures; Fatty Acids, Omega-3; Female; Humans; Male; Postoperative Complications; PubMed; Randomized Controlled Trials as Topic; Vitamin E; Vitamins

Oxidative stress has been strongly involved in the underlying mechanism of atrial fibrillation, particularly in the arrhythmia occurring in patients undergoing cardiac surgery with extracorporeal circulation (postoperative atrial fibrillation). The ischemia/reperfusion injury thus occurring in the myocardial tissue contributes to the development of tissue remodeling, thought to be responsible for the functional heart impairment. Consequently, structural changes due to the cardiac tissue biomolecules attack by reactive oxygen and/or nitrogen species could account for functional changes in ion channels, transporters, membrane conductance, cytosolic transduction signals, and other events, all associated with the occurrence of arrhythmic consequences. The lack of success and significant side effects of anti-arrhythmic drugs have given rise to attempts aimed to develop alternative novel pharmacologic treatments. On this line, the biological properties of the antioxidant vitamins C and E suggest that they could decrease the vulnerability of the heart to the oxidative damage. Nevertheless, very few studies to assess their anti-arrhythmic effects have been reported in humans. The clinical and experimental evidence supporting the view that the pharmacological use of antioxidant vitamins could contribute to prevent postoperative atrial fibrillation is presented.

Topics: Antioxidants; Ascorbic Acid; Atrial Fibrillation; Humans; Myocardial Reperfusion Injury; Oxidative Stress; Postoperative Complications; Vitamin E

To summarize recent findings on vitamin C status and assess the requirement and optimal dose of supplementation in surgical patients.. Blood vitamin C concentration falls after uncomplicated surgery and further decreases in surgical intensive care unit patients. The decline may be owing to increased demand caused by increased oxidative stress. To normalize plasma vitamin C concentration, much higher doses than the recommended daily allowance or doses recommended in parenteral nutrition guidelines are needed in these patients. In uncomplicated surgical patients, more than 500 mg/day of vitamin C may be required, with much higher doses in surgical intensive care unit patients. In uncomplicated gastrointestinal surgery, continuous parenteral administration of 500 mg/day of vitamin C reduced postoperative oxidative stress as manifested by reduced urinary excretion of isoprostane. In some studies, postoperative atrial fibrillation was prevented after cardiac surgery by perioperative vitamin C supplementation. In critically ill patients, some prospective randomized controlled trials support parenteral supplementation of high doses of vitamin C, E and trace elements.. Vitamin C requirement is increased in surgical patients, and the potential advantage of supplementation is to increase the plasma and tissue levels of vitamin C and thereby reduce oxidative stress. Although some clinical benefits of high-dose vitamin C supplementation have been shown in the critically ill, the optimal dose for supplementation and the clinical benefits remain to be investigated in surgical patients.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Critical Illness; Dietary Supplements; Humans; Nutrition Policy; Oxidative Stress; Parenteral Nutrition; Postoperative Care; Postoperative Complications

Topics: Abdomen; Abdominal Muscles; Ascorbic Acid; Female; Hernia; Humans; Jaundice; Laparotomy; Male; Methods; Microscopy, Electron, Scanning; Middle Aged; Postoperative Complications; Pressure; Risk; Surgical Wound Dehiscence; Surgical Wound Infection; Suture Techniques; Sutures; Uremia; Wound Healing

Topics: Acid-Base Equilibrium; Adaptation, Psychological; Ascorbic Acid; Dermatitis; Follow-Up Studies; Hemorrhage; Humans; Hydrogen-Ion Concentration; Ileum; Postoperative Care; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Urinary Catheterization; Urinary Diversion

Topics: Administration, Oral; Anticoagulants; Ascorbic Acid; Aspirin; Dextrans; Ethylestrenol; Fibrinogen; Heparin; Humans; Iodine Radioisotopes; Phenformin; Postoperative Complications; Thrombophlebitis

Topics: Anesthesia, Local; Animals; Ascorbic Acid; Bandages; Blood Circulation; Embolism; Hernia, Inguinal; Humans; Leg; Length of Stay; Male; Physical Exertion; Postoperative Care; Postoperative Complications; Rats; Rest; Surgical Wound Dehiscence; Thrombophlebitis; Wound Healing

Acute kidney injury (AKI) is associated with higher perioperative mortality and morbidity. Oxidative stress has been proposed as a cause of postoperative AKI. Ascorbic acid (AA) supplementation was suggested as a novel and promising antioxidant. The aim of this study was to evaluate the capability of AA to reduce the incidence of postoperative AKI in cardiac surgery patients.. A prospective randomized trial was conducted in patients scheduled for on-pump cardiac surgery. Subjects in the AA group received 2 g of AA intravenously during the induction of anesthesia, 2 g before aortic cross-clamp removal and 1 g every 8 hours for five postoperative days (the JERICA protocol). Postoperatively, the patients were monitored for AKI and other complications. Malondialdehyde levels were monitored in a subpopulation of 100 patients to evaluate the effect of AA on oxidative stress level.. Our results do not support the effectiveness of AA supplementation in reducing the incidence of postoperative AKI in on-pump cardiac surgery patients.. This study was registered with the ISRCTN Registry under the trial registration number ISRCTN98572043.

Topics: Acute Kidney Injury; Antioxidants; Ascorbic Acid; Cardiac Surgical Procedures; Humans; Incidence; Malondialdehyde; Postoperative Complications; Prospective Studies; Treatment Outcome

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Astigmatism; Corneal Pachymetry; Corneal Topography; Double-Blind Method; Female; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Prospective Studies; Visual Acuity; Young Adult

This study was designed to determine whether perioperative supplementation of vitamin C (VC) improves range of motion (ROM) and reduces the risk of arthrofibrosis (AF) following total knee arthroplasty (TKA).. Ninety-five patients undergoing TKA were randomized to either oral VC (1000 mg daily) or placebo for 50 days (48 VC group, 47 placebo group). The effect of VC supplementation was tested on ROM, AF, WOMAC, FJS-12, and VC plasma concentrations (VCc). VCc were analyzed in both patient groups before surgery, 4 and 7 days after surgery.. ROM at 1 year was not different between study groups. The prevalence of AF was 5 of 48 (10.4%) in the VC group compared to 11 of 47 (23.4%) in the placebo group (p = 0.09). VCc decreased post-operatively in the placebo group (49-12 µmol/l on day 7, p < 0.001), but not in the VC group (53-57 µmol/l). Patients with a perioperative drop of VCc ≥ 30 µmol/l developed significantly more AF at 1 year compared to patients with a VCc drop of < 30 µmol/l (p = 0.007).. TKA results in VC depletion. Perioperative VC supplementation prevents VCc drop in most patients undergoing TKA and may lower the incidence of AF. The clinical relevance of this study is that VC supplementation seems to be a cheap and safe adjunct to improve functional outcome after TKA.. I.. The study was registered at the ISRCTN registry with study ID ISRCTN40250576.

Topics: Administration, Oral; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Ascorbic Acid; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Knee Joint; Male; Middle Aged; Postoperative Care; Postoperative Complications; Range of Motion, Articular; Vitamins

Even minor postoperative reductions in renal function influence the outcome of cardiac surgery. The mechanisms of postoperative renal injury in cardiac surgery are multifactorial and include ischemia-reperfusion injury. The study investigates the effect of the antioxidant ascorbic acid on the postoperative acute kidney injury after elective CABG surgery.. A prospective randomized single-center trial was conducted in on-pump coronary artery bypass patients. The patients in the ascorbic acid group received 2 grams of ascorbic acid 24 hours and 2 hours preoperatively and 1 gram twice daily five days after the surgery.  Postoperatively, the subjects were monitored for renal dysfunction and other complications.. 100 patients were included, with 50 patients in each study group. The groups were well matched for baseline demographics, preoperative medications, comorbidities, and had similar intraoperative characteristics. The incidence of postoperative acute kidney injury in the ascorbic acid group was 16% and 14% in the control group (P = .779). The groups also did not differ in peak postoperative serum creatinine (83 [33] µmol/L versus 83 [39] µmol/L; P = .434), the lowest postoperative creatinine clearance (96.40 ± 35.78 mL/min versus 90.89 ± 36.18 mL/min; P = .766), and time from surgery to the onset of peak postoperative serum creatinine (1.64 ± 1.34 days versus 1.92 ± 1.54 days; P = .393). There was no dialysis required in any patient. Conclusion: The results of this study did not demonstrate a significant protective effect of ascorbic acid on the incidence of postoperative acute renal injury in elective on-pump CABG patients.

Topics: Acute Kidney Injury; Antioxidants; Ascorbic Acid; Coronary Artery Bypass; Dose-Response Relationship, Drug; Elective Surgical Procedures; Female; Humans; Incidence; Kidney Function Tests; Male; Middle Aged; Pilot Projects; Postoperative Complications; Prospective Studies; Risk Factors; Slovenia; Survival Rate

Atrial fibrillation is the most common arrhythmia following cardiac surgery. It is associated with increased hemodynamic instability, systemic embolization, and complications linked to anticoagulant therapy. Oxidative stress and consequent electrophysiological remodeling have been proposed as a cause of postoperative atrial fibrillation. Ascorbic acid supplementation was suggested as a novel and effective preventive agent. The aim of this study was to evaluate the capability of ascorbic acid to reduce the incidence of postoperative atrial fibrillation in coronary artery bypass grafting (CABG) patients.. A prospective randomized single-center trial was conducted in patients scheduled for an elective on-pump CABG surgery. Subjects in the ascorbic acid group received 2g of ascorbic acid 24h and 2h before the surgery and 1g twice a day for five days after the surgery. Postoperatively, the patients were monitored for atrial fibrillation and other complications.. The ascorbic acid group consisted of 52 patients and the control group included 53 patients. The groups were well matched for baseline demographics, preoperative medications, comorbidities, and had similar intraoperative characteristics. The incidence of atrial fibrillation in the ascorbic acid group was 13.5% and 18.9% in the control group (p=0.314). No difference was found between groups in the time of occurrence of atrial fibrillation (3.71±1.89 vs. 2.91±1.58 days after the surgery; p=0.342). There was also no difference in the other observed postoperative complications.. The results of this study do not support the effectiveness of ascorbic acid supplementation in reducing the incidence of postoperative atrial fibrillation in elective on-pump CABG patients.

Topics: Aged; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Coronary Artery Bypass; Female; Humans; Incidence; Male; Middle Aged; Perioperative Care; Postoperative Complications; Prospective Studies

Some evidences have shown the role of antioxidant vitamins in preventing atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery. We sought to determine the effect of oral vitamin C on the incidence of postoperative AF in patients undergoing elective isolated on-pump CABG surgery.. One-hundred patients who underwent isolated CABG surgery were prospectively assigned into two groups: Group 1 - 50 patients received 2 g of oral vitamin C before and 500 mg twice daily lasting for 5 days after surgery; Group 2 - 50 patients as the control group did not receive any. All patients were continuously monitored after surgery in the intensive careunit (ICU), and then Holter monitoring was implemented for 72 h.. The mean of patients' age was 61.31 ± 6.42 years. Postoperative AF occurred in 16 and 4 patients in control and treatment groups, respectively (32% vs. 8%, p = 0.003). The ICU stay was 1.79 ± 0.313 and 2.10 ± 0.61 days for vitamin C and control groups, respectively (p = 0.002). The hospital stay was significantly lower in vitamin C group compared with that of the control group (5.32 ± 0.59 vs. 5.74 ± 1.30 days, respectively, p = 0.041). Baseline erythrocyte sedimentation rate (OR 1.030, 95% CI 1.003-1.058, p = 0.030) and taking vitamin C (OR 8.068, 95% CI 1.783-36.517, p = 0.007) were the independent predictors of postoperative AF.. Oral vitamin C can be safely used to decrease the incidence of postoperative AF in patients undergoing elective isolated on-pump CABG surgery.

Topics: Administration, Oral; Ascorbic Acid; Atrial Fibrillation; Coronary Artery Bypass; Coronary Artery Disease; Dose-Response Relationship, Drug; Elective Surgical Procedures; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Treatment Outcome; Vitamins

This study was designed to assess whether the reinforcement of the antioxidant system, through n-3 fatty acids plus antioxidant vitamin supplementation, could reduce the incidence of post-operative atrial fibrillation.. Therapy to prevent post-operative atrial fibrillation remains suboptimal. Although oxidative stress plays a key role in the pathogenesis of this arrhythmia, antioxidant reinforcement has produced controversial results.. A total of 203 patients scheduled for on-pump cardiac surgery were randomized to placebo or supplementation with n-3 polyunsaturated fatty acids (2 g/day) (eicosapentaenoic acid:docosahexaenoic acid ratio 1:2), vitamin C (1 g/day), and vitamin E (400 IU/day). The primary outcome was the occurrence of post-operative atrial fibrillation. Secondary outcomes were the biomarkers related to oxidative stress and inflammation.. Post-operative atrial fibrillation occurred in 10 of 103 patients (9.7%) in the supplemented group versus 32 of 100 patients (32%) in the placebo group (p < 0.001). Early after surgery, placebo patients presented with increased levels of biomarkers of inflammation and oxidative stress, which were markedly attenuated by antioxidant supplementation. The activity of catalase, superoxide dismutase, and glutathione peroxidase in atrial tissue of the supplemented patients was 24.0%, 17.1%, and 19.7% higher than the respective placebo values (p < 0.05). The atrial tissue of patients who developed atrial fibrillation showed NADPH oxidase p47-phox subunit protein and mRNA expression 38.4% and 35.7% higher, respectively, than patients in sinus rhythm (p < 0.05).. This safe, well-tolerated, and low-cost regimen, consisting of n-3 polyunsaturated fatty acids plus vitamins C and E supplementation, favorably affected post-operative atrial fibrillation, increased antioxidant potential, and attenuated oxidative stress and inflammation. (Prevention of Post-Operative Atrial Fibrillation: Pathophysiological Characterization of a Pharmacological Intervention Based on a Novel Model of Nonhypoxic Pre-Conditioning; ISRCTN45347268).

Topics: Antioxidants; Ascorbic Acid; Atrial Fibrillation; Biomarkers; Cardiac Surgical Procedures; Dietary Supplements; Drug Monitoring; Fatty Acids, Omega-3; Female; Humans; Inflammation; Male; Middle Aged; Outcome Assessment, Health Care; Oxidative Stress; Postoperative Complications; Treatment Outcome; Vitamin E

To assess the usefulness of using ascorbic acid (vitamin C) administration in abdominal myomectomy.. A total of 102 patients were divided two groups in this prospective, clinical trial. Group A had received 2 g of ascorbic acid during a myomectomy, and group B had a myomectomy without any interventions. The operative time, blood loss, days of hospitalization, post-operative complications and rate of blood transfusions were compared between the two groups.. The blood loss (521.44 ± 199.24 vs. 932.9 ± 264.38 ml; p value <0.001), duration of the operation time (42 ± 13.9 vs. 68 ± 21.7 min; p value <0.001), days of hospitalization (2.7 ± 0.69 vs. 3.1 ± 0.59 days; p value 0.002) in group A were significantly less than in group B (p value 0.001). The chance risk ratio of a blood transfusion in group A was 0.4 (7.7 vs. 18% 95% CI of 0.1-1; p value 0.07). There was a significant correlation between the volume of bleeding and post-operative complications in both groups (p value in group A = 0.03; in group B = 0.004).. The administration of ascorbic acid (vitamin C) in abdominal myomectomy could reduce the blood loss during the procedure, operation time and days of hospitalization.

Topics: Adult; Antioxidants; Ascorbic Acid; Blood Loss, Surgical; Blood Transfusion; Female; Gynecologic Surgical Procedures; Hospitalization; Humans; Infusions, Intravenous; Leiomyoma; Postoperative Complications; Uterine Neoplasms

Oxidative stress due to ischemia/reperfusion injury increases systemic inflammation and impairs immune defenses. Much interest has developed for the administration of antioxidant substrates in surgical patients. The purpose of this study was to perform a pilot evaluation of the impact of a carbohydrate- containing preconditioning oral nutritional supplement (pONS) enriched with glutamine, antioxidants, and green tea extract on postoperative oxidative stress.. We performed a double-blind placebo-controlled randomized clinical trial, involving 36 cancer patients undergoing pancreaticoduodenectomy. Patients were randomized to receive either pONS or placebo twice the day before surgery and once 3 hours before surgery. Total endogenous antioxidant capacity (TEAC), plasma levels of vitamin C, vitamin E, selenium, zinc, F2-isoprostanes, and C-reactive protein were measured at baseline and on postoperative day (POD) 1, 3, and 7.. At surgery, the mean gastric residual volume (mL) was 54.2 in the pONS group versus 51.3 in the placebo group (P = NS). On POD 1 plasma levels of vitamin C (P = 0.001), selenium (P = 0.07), and zinc (P = 0.06) were higher in the pONS group compared to placebo. TEAC was improved on POD 1, 3, and 7 in the pONS group compared to placebo (P = 0.01). No difference was found in plasma C-reactive protein levels after surgery in both groups.. Perioperative pONS administration positively affected plasma vitamin C levels and improved TEAC shortly after surgery, but did not reduce oxidative stress and systemic inflammation markers.

Topics: Aged; Antioxidants; Ascorbic Acid; Common Bile Duct Neoplasms; Dietary Supplements; Double-Blind Method; Humans; Male; Middle Aged; Oxidative Stress; Pancreas; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pilot Projects; Postoperative Complications; Preoperative Care; Reperfusion Injury; Selenium; Zinc

Surgery is accompanied by a surgical stress response, which results in increased morbidity and mortality. Oxidative stress is a part of the surgical stress response. Minimally invasive laparoscopic surgery may result in reduced oxidative stress compared with open surgery. Nineteen patients scheduled for sigmoid resection were randomly allocated to open or laparoscopic sigmoid resection in a double-blind, prospective clinical trial. Three biochemical markers of oxidative stress (malondialdehyde, ascorbic acid, and dehydroascorbic acid) were measured at 6 different time points (preoperatively, 1 h, 6 h, 24 h, 48 h, and 72 h postoperatively). There were no statistical significant differences between laparoscopic and open surgery for any of the 3 oxidative stress parameters. Malondialdehyde was reduced 1 hour postoperatively (P<0.001) for all 19 patients. There was a significant drop in ascorbic acid at 1 hour and 6 hours after the first abdominal incision (P=0.002) for all 19 patients. Laparoscopic surgery was not found to be associated with reduced oxidative stress.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Ascorbic Acid; Biomarkers; Colon, Sigmoid; Dehydroascorbic Acid; Diverticulosis, Colonic; Double-Blind Method; Female; Humans; Laparoscopy; Male; Malondialdehyde; Middle Aged; Oxidative Stress; Postoperative Complications; Prospective Studies; Sigmoid Neoplasms; Treatment Outcome

Corneal haze is a significant complication of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK).. To evaluate the effect of ascorbic acid supplementation in addition to perioperative topical mitomycin-C for the prevention of haze after LASEK.. We performed a retrospective, non-randomized case series study of two groups of 48 consecutive patients (96 myopic eyes) who had LASEK surgery. The treatment group was given ascorbic acid (vitamin C) orally, 500 mg, twice daily from 1 week before to 2 weeks after surgery. The control group was not offered any additional treatment. Ascorbate supplementation was the only difference in the postoperative treatment protocol between the treatment and control groups. Haze was assessed on a scale from 0 to 4 at the 1 year visit.. Overall, 33.3% and 37.5% of the patients in the treatment and control groups respectively developed corneal haze. The trend of increased haze severity in the control group did not reach statistical significance.. Our results showed that systemic ascorbate supplementation does not have an additional effect on the prevention of haze after LASEK compared to the effect of topical mitomycin-C alone.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Astigmatism; Cornea; Corneal Opacity; Drug Therapy, Combination; Female; Humans; Keratectomy, Subepithelial, Laser-Assisted; Male; Mitomycin; Postoperative Complications; Retrospective Studies; Young Adult

Atrial fibrillation occurs after approximately 25% to 45% of coronary artery bypass graft (CABG) surgeries. Oxidative stress and related electrophysiological remodeling has been proposed as a potential cause of this atrial fibrillation. Perioperative supplementation of the antioxidant ascorbic acid has been evaluated as a preventive agent. The current investigation was conducted to evaluate the efficacy of ascorbic acid in reducing atrial fibrillation in CABG patients.. A prospective, randomized, placebo-controlled, triple-blind, single-institution study was conducted in nonemergency CABG patients. Subjects were monitored for episodes of arrhythmia and other complications.. Eighty-nine treatment and 96 control subjects completed the study protocol. Demographics, comorbidities, and preoperative drugs were similar between groups. Surgical characteristics and postoperative medication use also were similar. The incidence of atrial fibrillation was 30.3% in the treatment group and 30.2% in the control group (P = .985). No difference was found in postoperative complications or mortality.. Our data indicate that supplementation of ascorbic acid in addition to routine postoperative care does not reduce atrial fibrillation after coronary artery bypass grafting.

Topics: Administration, Oral; Aged; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Coronary Artery Bypass; Dietary Supplements; Double-Blind Method; Drug Administration Schedule; Enteral Nutrition; Female; Humans; Incidence; Male; Middle Aged; Perioperative Care; Postoperative Complications; Prospective Studies; Treatment Outcome

Atrial fibrillation (AF) is a common arrhythmia that occurs postoperatively in cardiac surgery. There is evidence for the role of oxidative stress in the etiology of AF. In our study, we examined whether antioxidant ascorbic acid (vitamin C), could help in the reduction of the incidence of postoperative AF. Patients who were scheduled to undergo elective isolated on-pump coronary artery bypass grafting (CABG) were included in our study. One hundred and seventy patients were randomly divided in two groups: Group A (n=85) received vitamin C preoperatively and postoperatively whereas Group B (n=85) did not receive any (control group). The incidence of AF was 44.7% in the vitamin C group and 61.2% in the control group (P=0.041). The hospitalization time, the intensive care unit stay and the time interval for the conversion of AF into sinus rhythm was significantly shorter in the vitamin C group. Patients that developed AF also had longer hospital length of stay (9.5±2.8 days vs. 6.7±1.9, P=0.034). Supplementation of vitamin C reduces the incidence of postCABG AF, and decreases the time needed for rhythm restoration and length of hospital stay.

Topics: Aged; Analysis of Variance; Ascorbic Acid; Atrial Fibrillation; Coronary Artery Bypass; Coronary Disease; Elective Surgical Procedures; Female; Follow-Up Studies; Humans; Length of Stay; Male; Myocardial Revascularization; Pilot Projects; Postoperative Care; Postoperative Complications; Preoperative Care; Prospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Rate; Treatment Outcome

Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl.. The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 x 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81).. Overall, 103 of 196 patients (52.5%) received at least one ABT unit (2.1 +/- 1.0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0.013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12.7 +/- 1.0 g/dl vs. 11.9 +/- 0.8 g/dl, respectively; P = 0.030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed.. In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks.

Topics: Aged; Aged, 80 and over; Ascorbic Acid; Blood Loss, Surgical; Blood Transfusion; Epoetin Alfa; Erythropoietin; Female; Ferric Compounds; Ferric Oxide, Saccharated; Folic Acid; Fracture Fixation, Internal; Glucaric Acid; Guideline Adherence; Hip Fractures; Hospitals, University; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Recombinant Proteins; Retrospective Studies; Vitamin B 12

Muscle atrophy and weakness are predominant impairments after anterior cruciate ligament (ACL) surgical repair. We tested the hypothesis that vitamin E and C supplementation will improve recovery from ACL injury. Men undergoing elective ACL surgery were randomly assigned to twice-daily supplements of either antioxidants (AO; vitamins E and C, n=10) or matching placebos (n=10) from 2 weeks before until 3 months after surgery. Each subject provided several fasting blood draws, two muscle biopsies from the thigh muscle of the injured limb, and strength and thigh circumference measurements of the lower limbs. Muscle atrophy was apparent in both groups before and several days after surgery. Compared with baseline measurements, peak isometric force of the injured limb increased significantly (P<0.05) by 3 months postsurgery in both treatment groups; however, AO supplementation did not augment these strength gains. By contrast, baseline plasma ascorbic acid concentrations correlated (r=0.59, P=0.006) with subsequent improvement in the strength of the injured limb. In summary, vitamin E and C supplementation was ineffective in potentiating the improvement in force production by the injured limb; however, baseline vitamin C status was associated with beneficial outcomes in strength, suggesting that long-term dietary habits are more effective than short-term supplements.

Topics: Anterior Cruciate Ligament; Ascorbic Acid; Biopsy; Body Size; Dietary Supplements; Humans; Lower Extremity; Male; Muscle Strength; Muscular Atrophy; Orthopedic Procedures; Postoperative Complications; Recovery of Function; Tocopherols

A decrease in ascorbic acid (AA) plasma concentration is well known during the postoperative period and postulated to be caused by increased radical scavenging activity in response to surgical trauma. This often affects postoperative patients and is associated with multiple organ failure. Therefore, substitution of AA could potentially decrease the risk of postoperative complications. This study examines the effect of preoperative oral administration of 1,000 mg AA on the postoperative AA plasma concentration.. 54 patients were randomly split into two groups; patients in group 1 received no AA preoperatively while group 2 received oral AA (1,000 mg). Plasma samples were obtained preoperatively and on the first postoperative day for AA analysis (HPLC).. In both groups the AA concentration was normal preoperatively and reduced postoperatively.. A preoperative substitution of 1,000 mg AA is not sufficient to prevent postoperative lowered plasma concentration.

Topics: Administration, Oral; Aged; Antioxidants; Ascorbic Acid; Humans; Middle Aged; Multiple Organ Failure; Postoperative Complications; Postoperative Period; Preoperative Care; Surgical Procedures, Operative

To determine the effectiveness of early, routine antioxidant supplementation using alpha-tocopherol and ascorbic acid in reducing the rate of pulmonary morbidity and organ dysfunction in critically ill surgical patients.. Oxidative stress has been associated with the development of the acute respiratory distress syndrome (ARDS) and organ failure through direct tissue injury and activation of genes integral to the inflammatory response. In addition, depletion of endogenous antioxidants has been associated with an increased risk of nosocomial infections. The authors postulated that antioxidant supplementation in critically ill surgical patients may reduce the incidence of ARDS, pneumonia, and organ dysfunction.. This randomized, prospective study was conducted to compare outcomes in patients receiving antioxidant supplementation (alpha-tocopherol and ascorbate) versus those receiving standard care. The primary endpoint for analysis was pulmonary morbidity (a composite measure of ARDS and nosocomial pneumonia). Secondary endpoints included the development of multiple organ failure, duration of mechanical ventilation, length of ICU stay, and mortality.. Five hundred ninety-five patients were enrolled and analyzed, 91% of whom were victims of trauma. The relative risk of pulmonary morbidity was 0.81 (95% confidence interval 0.60-1.1) in patients receiving antioxidant supplementation. Multiple organ failure was significantly less likely to occur in patients receiving antioxidants than in patients receiving standard care, with a relative risk of 0.43 (95% confidence interval 0.19-0.96). Patients randomized to antioxidant supplementation also had a shorter duration of mechanical ventilation and length of ICU stay.. The early administration of antioxidant supplementation using alpha-tocopherol and ascorbic acid reduces the incidence of organ failure and shortens ICU length of stay in this cohort of critically ill surgical patients.

Topics: Adolescent; Adult; Aged; alpha-Tocopherol; Antioxidants; Ascorbic Acid; Confidence Intervals; Critical Illness; Dietary Supplements; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multiple Organ Failure; Postoperative Complications; Postoperative Period; Probability; Prospective Studies; Reference Values; Respiratory Distress Syndrome; Surgical Procedures, Operative; Survival Analysis; Treatment Outcome; Wounds and Injuries

In this study, we aimed to compare the myocardial protective effects of high dose ascorbic acid with the effects obtained by adding diltiazem to high dose ascorbic acid. We studied 30 elective cardiac surgery patients prospectively. In ascorbic acid group (group AA), ascorbic acid was given after induction and just before aortic declamping, 50 mg.kg-1 each time. In ascorbic acid + diltiazem group (group AA + D), diltiazem was added to ascorbic acid (0.3 mg.kg-1, i.v. after induction and then 2 micrograms.kg-1 min-1 i.v. infusion until declamping). Group C was the control group. There was no significant difference between groups in terms of cardiac enzyme levels. After declamping, the arterial and coronary sinus malondialdehyde levels, measured as a marker of lipid peroxidation, were increased significantly in the group C while remained stable in the other two groups. Ventricular fibrillation (VF) after declamping was positive in 3, 1 and 6 patients in the groups AA, AA + D and C respectively. In this study, we observed the prevention of lipid peroxidation in the group AA and group AA + D. The only positive result obtained by addition of diltiazem to high dose ascorbic acid was the decrease in the frequency of VF after declamping. We concluded that the prevention of lipid peroxidation in the groups AA and AA + D provided no measurable protection over myocardial ischaemia-reperfusion injury.

Topics: Adult; Aged; Ascorbic Acid; Calcium Channel Blockers; Coronary Artery Bypass; Diltiazem; Female; Hemodynamics; Humans; Lipid Peroxidation; Male; Malondialdehyde; Middle Aged; Myocardial Reperfusion Injury; Myocardium; Postoperative Complications; Prospective Studies; Ventricular Fibrillation

The purpose of our study was to evaluate the clinical impact of reperfusion injury after normothermic ischemia during major liver resections and the effect of an intraoperative antioxidant infusion. This prospective randomized study comprised 50 patients; half of them (treatment group) were given an antioxidant infusion containing tocopherol and ascorbate immediately prior to reperfusion onset. Venous blood samples for the determination of MDA-TBARS (malondialdehyde-thiobarbituric acid reactive substances) by a HPLC-based test as a marker of lipid peroxidation were taken prior to ischemia, 30 min after reperfusion onset and at the end of the operation. In the control group there was a significant increase of MDA-TBARS (p = 0.001) at 30 min after reperfusion onset. At the end of the operation the values had returned to the initial level. The treatment group showed only a marginal increase (p-value for the difference between the two groups: 0.007). After exclusion of the patients with histologically proven advanced cirrhosis the increase in the control group (p < 0.001) and the difference between the increase in the two groups (p = 0.001) became more significant. Prothrombin time was also significantly better in the treatment group (p = 0.003). Postoperative complications such as prolonged liver failure, bleeding disorders and infections were seen more often in the control group. In our study MDA-TBARS was increased after liver ischemia, but in patients with advanced cirrhosis the effect was smaller or even absent. This increase and possible clinical consequences of reperfusion injury could be reduced by intraoperative administration of an antioxidant infusion.

Topics: Antioxidants; Ascorbic Acid; Humans; Lipid Peroxidation; Liver; Liver Cirrhosis; Malondialdehyde; Postoperative Complications; Prothrombin Time; Reperfusion Injury; Temperature; Thiobarbituric Acid Reactive Substances; Time Factors; Transaminases; Vitamin E

Antioxidants may reduce pancreatic cellular injury after coronary artery bypass grafting (CABG) Twenty patients (Group A) received vitamin E (600 mg/ day) for 28 days and vitamin C (2 g/day) and allopurinol (600 mg/day) 2 days before and 1 day after CABG. Seventeen patients (Group C) received all drugs for 3 days, and 25 (Group B) and 19 (Group D) patients served as corresponding controls. The pre- and postoperative pancreatic isoamylase (P-amylase), creatinine, and antioxidant concentrations were measured. Serum hyperamylasemia was highest on the first postoperative day and occurred in 73% of the patients. After surgery serum P-amylase increased in all study groups and urine P-amylase decreased. Postoperative serum hyperamylasemia, whether primarily renal or pancreatic, cannot be decreased by pretreatment with allopurinol, vitamin C, and vitamin E.

Topics: Aged; Allopurinol; Amylases; Antioxidants; Ascorbic Acid; Coronary Artery Bypass; Creatinine; Female; Humans; Isoenzymes; Male; Middle Aged; Pancreas; Postoperative Complications; Prospective Studies; Vitamin E

The suitability of complex administration of antioxidants (vitamins C, E and A) for prevention of postoperative complications was assessed in a randomized study which included 197 cases of gastric cancer. The treatment was followed by a lowering of lipid peroxidation process. In a group of 95 patients who had received the drugs preoperatively, the postoperative complication rate dropped from 30.9 to 1.9%.

Topics: Antioxidants; Ascorbic Acid; Energy Metabolism; Humans; Lipid Peroxidation; Peptides; Postoperative Complications; Stomach Neoplasms; Vitamin A; Vitamin E

In a prospective, randomized, controlled study an intravenous vitamin B complex and vitamin C preparation was administered pre- and post-operatively to 28 elderly patients with a fractured proximal femur and compared with 32 nonsupplemented postoperative controls. Vitamin supplementation significantly, though only transiently, improved postoperative thiamine status (P less than 0.001), but had no influence on mental state or outcome during the postsurgical period. Therefore, the use of parenteral vitamins for postoperative confusion cannot be justified on a routine basis.

Topics: Aged; Aged, 80 and over; Ascorbic Acid; Cognition Disorders; Confusion; Female; Femoral Fractures; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Thiamine; Vitamin B Complex

Topics: Adolescent; Adult; Ascorbic Acid; Aspirin; Edema; Humans; Mouth; Phenylbutazone; Postoperative Complications

Forty-four general surgical patients were included in a prospective, randomized double-blind controlled trial of ascorbic acid (500 mg b.d.) or placebo for 7 days before operation. This was to test the hypothesis that vitamin C may reduce the instance of deep venous thrombosis postoperatively. Venous blood samples were taken before entering the trial, just immediately before surgery, on the day of operation and on three further occasions at 3-day intervals postoperatively for leucocyte ascorbic acid concentration (LAC). Venous thrombosis was diagnosed using the 125I-fibrinogen test and the leg scans interpreted by Roberts' criteria. There was no significant difference in the incidence of DVT between the treatment and placebo groups. In those with DVT (n = 23) the mean LAC on the day of operation was not significantly different from that in those without DVT. However, on the sixth and ninth postoperative days LAC levels were significantly lower in the DVT group. These results suggest that the administration of ascorbic acid preoperatively does not reduce the incidence of DVT, but a striking decrease in the LAC levels in the DVT patients is in keeping with the hypothesis that the initial event in the pathogenesis of DVT is adherence of leucocytes to the venous endothelium.

Topics: Ascorbic Acid; Clinical Trials as Topic; Double-Blind Method; Humans; Leukocytes; Placebos; Postoperative Complications; Postoperative Period; Random Allocation; Thrombophlebitis

In a prospective double-blind controlled trial the effect of large doses of ascorbic acid on the healing of pressure-sores has been assessed. 20 surgical patients were studied, the pressure areas being assessed by serial photography and ulcer tracings. The mean ascorbic-acid levels in treated and non-treated groups one month after the start of treatment were 65.6 and 25.8 mug per 10-8 white blood-cells. In the group treated with ascorbic acid there was a mean reduction in pressure-sore area of 84% after one month compared with 42.7% in the placebo group. These findings are statistically significant (P less than 0.005) and suggest that ascorbic acid may accelerate the healing of pressure-sores.

Topics: Aged; Arthritis, Rheumatoid; Ascorbic Acid; Ascorbic Acid Deficiency; Cerebrovascular Disorders; Clinical Trials as Topic; Female; Fractures, Bone; Humans; Leukocytes; Male; Middle Aged; Paraplegia; Postoperative Complications; Pressure Ulcer; Prospective Studies; Vascular Diseases; Wound Healing

Topics: Adult; Aged; Ascorbic Acid; Carbonates; Clinical Trials as Topic; Copper; Female; Humans; Male; Middle Aged; Mucus; Postoperative Care; Postoperative Complications; Respiratory Therapy; Sputum; Sulfates; Surface-Active Agents; Thoracic Surgery; Thorax; Viscosity

Topics: Ascorbic Acid; Cardiac Surgical Procedures; Humans; Postoperative Complications; Postoperative Period; Vitamins

Lipid peroxidation represents a marker of secondary brain injury both in traumatic and in non-traumatic conditions-as in major neurosurgical procedures-eventually leading to brain edema amplification and further brain damage. Malondialdehyde (MDA), a lipid peroxidation marker, and ascorbate, a marker of antioxidant status, can represent early indicators of this process within the cerebrospinal fluid (CSF). We hypothesized that changes in cerebral lipid peroxidation can be measured ex vivo following neurosurgery in children.. Thirty-six children (M:F = 19/17, median age 32.9 months; IQR 17.6-74.6) undergoing neurosurgery for brain tumor removal were admitted to the pediatric intensive care unit (PICU) in the postoperative period with an indwelling intraventricular catheter for intracranial pressure monitoring and CSF drainage. Plasma and CSF samples were obtained for serial measurement of MDA, ascorbate, and cytokines.. An early brain-limited increase in lipid peroxidation was measured, with a significant increase from baseline of MDA in CSF (p = 0.007) but not in plasma. In parallel, ascorbate in CSF decreased (p = 0.05). Systemic inflammatory response following brain surgery was evidenced by plasma IL-6/IL-8 increase (p 0.0022 and 0.0106, respectively). No correlation was found between oxidative response and tumor site or histology (according to World Health Organization grading). Similarly, lipid peroxidation was unrelated to the length of surgery (mean 321 ± 73 min), or intraoperative blood loss (mean 20.9 ± 16.8% of preoperative volemia, 44% given hemotransfusions). Median PICU stay was 3.5 days (IQL range 2-5.5 d.), and postoperative ventilation need was 24 h (IQL range 20-61.5 h). The elevation in postoperative MDA in CSF compared with preoperative values correlated significantly with postoperative ventilation need (P = 0.05, r. Our results indicate that lipid peroxidation increases consistently following brain surgery, and it is accompanied by a decrease in antioxidant defences; intraventricular catheterization offers a unique chance of oxidative process monitoring. Further studies are needed to evaluate whether monitoring post-neurosurgical oxidative stress in CSF is of prognostic utility.

Topics: Antioxidants; Ascorbic Acid; Brain Injuries; Brain Neoplasms; Child; Child, Preschool; Cytokines; Drainage; Female; Humans; Infant; Intensive Care Units, Pediatric; Interleukin-6; Interleukin-8; Intracranial Pressure; Lipid Peroxidation; Male; Malondialdehyde; Monitoring, Physiologic; Neurosurgical Procedures; Oxidative Stress; Postoperative Complications; Respiration, Artificial

Topics: Abscess; Adult; Aged; Ankle Joint; Arthralgia; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Hematoma; Humans; Knee Joint; Male; Middle Aged; Postoperative Complications; Scurvy

Atrial fibrillation is one of the most frequent complications and a major risk of morbidity and mortality after cardiac surgery. Antioxidants such as vitamin C are used for prevention of this arrhythmia. Different results of studies have been reported, but most of them have shown efficiency of vitamin C in prophylaxis of postoperative AF. We tried to examine this efficacy with larger sample size.. Three hundred and fourteen on pump coronary artery bypass graft surgery alone. Patients were divided into two groups: The intervention group received vitamin C (N = 160) and the control group did not receive any (N = 154). Intervention group was administered two grams of vitamin C intravenously (IV) 24 hours preoperatively, 500 mg every 12 hours IV for 48 hours in ICU, and 500 mg every 12 hours PO for 48 hours in ward. Continuous monitoring in ICU and three times a day ECG was used for AF detection. The two groups were compared.. The two groups were matched in terms of age, sex, LA size, ejection fraction, functional class, and TSH level. Of the patients, 244 were male. Mean age was 62 years (40-84 years) in both groups. M/F ratio was four in both groups. Functional class and ejection fraction were the same in both groups. There was no mean TSH level difference. AF occurrence in vitamin C group was 7.6 % and in control group was 7.8 %. There was no difference in ICU or hospital stay.. Prophylactic use of vitamin C does not further reduce postoperative atrial fibrillation in on pump CABG patients.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Coronary Artery Bypass; Coronary Artery Disease; Double-Blind Method; Female; Humans; Incidence; Iran; Length of Stay; Male; Middle Aged; Postoperative Care; Postoperative Complications; Prognosis; Survival Rate

Topics: Anticoagulants; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Humans; Postoperative Complications; Sample Size; Stroke

Surgically induced necrotizing scleritis (SINS) is a rare but serious disorder that can develop many years after strabismus surgery. It is generally treated with high-dose steroids or immunosuppression.. We describe a patient with Varadi Papp syndrome and congenital fibrosis of the extraocular muscles, who developed surgically induced necrotizing scleritis a month after strabismus surgery and was successfully managed by oral vitamin C and topical N-acetylcysteine 10%.. While SINS is conventionally treated with steroids/immunosuppression, a conservative approach may be tried in milder cases. The role of topical N-acetylcysteine in managing this complication needs to be explored.

Topics: Acetylcysteine; Administration, Topical; Ascorbic Acid; Child; Fibrosis; Free Radical Scavengers; Humans; Male; Oculomotor Muscles; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Ophthalmoplegia; Orofaciodigital Syndromes; Postoperative Complications; Scleritis; Strabismus

Topics: Anti-Arrhythmia Agents; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Cardiac Surgical Procedures; Humans; Postoperative Complications; Publication Bias; Treatment Outcome

To investigate the effectiveness of intraperitoneal vitamin C (VC) and vitamin E (VE) in the prevention of postoperative adhesion formation in a rat uterine horn model.. Twenty-eight Wistar albino rats were divided into four groups in which: control group, the abdomen was opened and closed without any intervention; adhesion group, a 2-cm linear incision was performed on the uterine horn and closed; VC group, VC was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed; and VE group, VE was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed. Re-laparotomy was performed 15 days later. Right uterine horn adhesions were evaluated according to macromorphological characteristics and tissue sections were further examined for fibrosis, angiogenesis and vascular endothelial growth factor (VEGF), type I collagen and malondialdehyde (MDA) scoring. Kruskal-Wallis anova and Mann-Whitney U-test were utilized for statistical analysis.. Adhesion area and also strength were significantly lower in the VC group and the VE group compared with the adhesion group. Fibrosis and angiogenesis scores were observed to be significantly higher in the adhesion group compared with the VC group and the VE group. MDA and VEGF immunoreactivity were also found to be significantly lower in the VC group and the VE group compared with the adhesion group. However, there was no significant difference between the VC group and the VE group with respect to all the above parameters.. Administration of VC or VE i.p. was observed to be effective in the prevention of postoperative adhesion formation in an experimental model.

Topics: Animals; Antioxidants; Ascorbic Acid; Female; Injections, Intraperitoneal; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Uterine Diseases; Uterus; Vitamin E

We have studied the role of oxidant stress in development of rhythm disturbances in early postoperative period after coronary artery bypass grafting and possibilities of their prevention with preparations of ascorbinic acid. It was shown that the use of β-adrenoblockers allows to prevent arrhythmia on first day after operation only in 80% of cases. Patients with developed disturbances of cardiac rhythm were characterized by high parameters of lipid peroxidation (LPO) and substantial changes of activity of antioxidant enzyme catalase. Administration of ascorbinic acid at the stage of preparation of patients to surgery and in first 24 hours after operation allowed to effectively prevent development of oxidative stress and disturbances of cardiac rhythm. A conclusion was made that inclusion of ascorbinic acid in drug therapy of patients with ischemic heart disease could be recommended for prevention of arrhythmia in postoperative period.

Topics: Aged; Antioxidants; Arrhythmias, Cardiac; Ascorbic Acid; Coronary Artery Bypass; Drug Monitoring; Humans; Male; Middle Aged; Myocardial Ischemia; Oxidative Stress; Postoperative Care; Postoperative Complications; Time Factors; Treatment Outcome

Topics: Anesthetics, Local; Ascorbic Acid; Circumcision, Male; Cyanosis; Humans; Infant; Male; Methemoglobinemia; Postoperative Complications; Prilocaine; Reducing Agents

Topics: Ascorbic Acid; Bariatric Surgery; Calcium Oxalate; Diabetes Mellitus, Type 2; Humans; Kidney Calculi; Postoperative Complications; Risk Factors

Iron deficiency and iron deficiency anemia are common in patients who undergo gastric bypass. The magnitude of change in iron absorption is not well known.. The objective was to evaluate the effects of Roux-en-Y gastric bypass (RYGBP) on iron status and iron absorption at different stages after surgery. We hypothesized that iron absorption would be markedly impaired immediately after surgery and would not improve after such a procedure.. Anthropometric, body-composition, dietary, hematologic, and iron-absorption measures were determined in 67 severe and morbidly obese women [mean age: 36.9 +/- 9.8 y; weight: 115.1 +/- 15.6 kg, body mass index (BMI: in kg/m(2)); 45.2 +/- 4.7] who underwent RYGBP. The Roux-en-Y loop length was 125-150 cm. Determinations were carried out before and 6, 12, and 18 mo after surgery. Fifty-one individuals completed all 4 evaluations.. The hemoglobin concentration decreased significantly throughout the study (repeated-measures analysis of variance). The percentage of anemic subjects changed from 1.5% at the beginning of the study to 38.8% at 18 mo. The proportion of patients with low serum ferritin increased from 7.5% to 37.3%. The prevalence of iron deficiency anemia was 23.9% at the end of the experimental period. Iron absorption from both a standard diet and from a standard dose of ferrous ascorbate decreased significantly after 6 mo of RYGBP to 32.7% and 40.3% of their initial values, respectively. No further significant modifications were noted.. Iron absorption is markedly reduced after RYGBP with no further modifications, at least until 18 mo after surgery.

Topics: Adolescent; Adult; Anastomosis, Roux-en-Y; Anemia, Iron-Deficiency; Ascorbic Acid; Diet; Female; Ferritins; Gastric Bypass; Hemoglobins; Humans; Intestinal Absorption; Iron; Iron, Dietary; Obesity, Morbid; Postoperative Complications; Prevalence; Young Adult

Topics: Adolescent; Antioxidants; Ascorbic Acid; Child; Chromosome Disorders; Dipeptidases; Forehead; Humans; Male; Nose Deformities, Acquired; Plastic Surgery Procedures; Postoperative Complications; Skin Transplantation; Skin Ulcer; Surgical Flaps; Syndrome; Wound Healing

Topics: Aged; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Atrial Fibrillation; Coronary Artery Disease; Humans; Male; Myocardial Revascularization; Postoperative Complications; Risk Factors

Dapsone can alter the oxygen carrying capacity of haemoglobin. Some patients are more susceptible to these effects because of genetic factors, comorbidities or peri-operative factors such as anaemia. We present a 57-year-old lady who underwent elective coronary artery bypass grafting. Deterioration in neurological and respiratory condition prompted a review of her drug treatment. A combination of long-term dapsone therapy, co-existing cardiac and respiratory disease, postoperative anaemia and renal impairment contributed to her decompensation, despite a relatively low level of methaemoglobin. Successful management included stopping dapsone therapy, supportive care and administration of ascorbic acid.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antioxidants; Ascorbic Acid; Coronary Artery Bypass; Dapsone; Female; Humans; Hypoxia, Brain; Methemoglobinemia; Middle Aged; Postoperative Complications

Topics: Adrenergic beta-Antagonists; Antioxidants; Ascorbic Acid; Atrial Fibrillation; Beverages; Coronary Artery Bypass; Drug Therapy, Combination; Humans; Postoperative Complications

Oxidative stress seems to contribute to cardiopulmonary bypass (CPB)-related postoperative complications. Pediatric patients are particularly prone to these complications. With this in mind, we measured oxidative stress markers in blood plasma of 20 children undergoing elective heart surgery before, during, and up to 48 h after cessation of CPB, along with inflammatory parameters and full analysis of iron status. Ascorbate levels were decreased by approximately 50% (P < 0.001) at the time of aorta cross-clamp removal (or pump switch-off in 4 patients with partial CPB), and associated with corresponding increases in dehydroascorbate (P < 0.001, r = -0.80) and malondialdehyde (P < 0.01, r = -0.59). In contrast to the immediate oxidative response, peak levels of IL-6 and IL-8 were not observed until 3-12 h after CPB cessation. The early loss of ascorbate correlated with duration of CPB (P < 0.002, r = 0.72), plasma hemoglobin after cross-clamp removal (P < 0.001, r = 0.70), and IL-6 and IL-8 levels at 24 and 48 h after CPB (P < 0.01), but not with postoperative lactate levels, strongly suggesting that hemolysis, and not inflammation or ischemia, was the main cause of early oxidative stress. The correlation of ventilation time with early changes in ascorbate (P < 0.02, r = 0.55), plasma hemoglobin (P < 0.01, r = 0.60), and malondialdehyde (P < 0.02, r = 0.54) suggests that hemolysis-induced oxidative stress may be an underlying cause of CPB-associated pulmonary dysfunction. Optimization of surgical procedures or therapeutic intervention that minimize hemolysis (e.g., off-pump surgery) or the resultant oxidative stress (e.g., antioxidant treatment) should be considered as possible strategies to lower the rate of postoperative complications in pediatric CPB.

Topics: Ascorbic Acid; C-Reactive Protein; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Child, Preschool; Dehydroascorbic Acid; Heart Defects, Congenital; Hemolysis; Humans; Infant; Interleukin-6; Interleukin-8; Iron; Ischemia; Malondialdehyde; Neutrophils; Oxidative Stress; Pneumonia; Postoperative Complications; Prospective Studies

Methemoglobinemia, although rare, must be considered in surgical patients presenting with acute respiratory distress and cyanosis. We report two cases of methemoglobinemia in patients undergoing aortic reconstruction. The first patient developed methemoglobinemia while on a nitroglycerin infusion, and the second after receiving benzocaine spray before intubation. Both patients were treated with methylene blue and ascorbic acid, with resolution of their hypoxia and cyanosis. The pathophysiology, etiology, diagnosis, and treatment of methemoglobinemia are reviewed.

Topics: Aged; Antioxidants; Ascorbic Acid; Blood Vessel Prosthesis Implantation; Cyanosis; Enzyme Inhibitors; Female; Humans; Methemoglobinemia; Methylene Blue; Middle Aged; Postoperative Complications; Treatment Outcome

Study of relationship between the content of lipid peroxidation (LPO) products in the blood of patients with benign prostatic hyperplasia (BPH) and resistance to infectious inflammatory complications (IIC) of transurethral electroresection of the prostate showed that decreased content of circulating lipoperoxides promoted the development of postoperative IIC. Before the operation blood levels of LPO products were increased in BPH patients who did not develop IIC postoperation in comparison with normal controls. Three intravenous injections of ascorbic acid in a single dose of 1000 mg after transurethral electroresection of the prostate led to an increase in the blood level of LPO products and promoted a decrease in the incidence of postoperative IIC.

Topics: Antioxidants; Ascorbic Acid; Bacterial Infections; Biomarkers; Humans; Inflammation; Injections, Intravenous; Lipid Peroxidation; Male; Postoperative Complications; Prostatic Hyperplasia; Transurethral Resection of Prostate

Diffuse hemorrhage in surgical patients with normal coagulation parameters may be caused by vitamin C deficiency and is rapidly reversed by vitamin C replacement.. Patients treated on a surgical service were entered into a clinical registry over a 12-month period if they experienced diffuse hemorrhage in the face of normal coagulation parameters and a plasma ascorbic acid level < 0.6 mg/dL (normal 0.6-2.0 mg/dL). Oral vitamin C replacement was administered after determination of plasma ascorbic acid level. Response to therapy, including subsequent bleeding events, need for blood transfusions, and demographic data including social and dietary history were retrospectively reviewed from hospital and outpatient clinic records.. Twelve patients with bleeding diatheses and low plasma ascorbic acid levels were identified. Plasma ascorbic acid levels were 0.1 to 0.5 mg/dL (mean, 0.3 mg/dL). There were 6 men and 6 women; age ranged from 46 to 90 years (mean, 78 years). Coagulation parameters were normal in all patients. Diffuse postoperative bleeding from nonsurgical causes was evident in 10 of 12 patients. Four patients, 2 of whom had operations, presented with chronic recurrent blood loss from the gastrointestinal tract. Each patient received 250 to 1000 mg of vitamin C replacement daily. Within 24 hours of vitamin C administration, there was no further evidence of clinical bleeding nor need for subsequent blood transfusions in any patient.. Vitamin C deficiency should be included in the differential diagnosis of nonspecific bleeding in surgical patients. Prolonged hospitalization, severe illness, and poor diet create vitamin C deficiency with significant clinical consequences. Oral vitamin C replacement rapidly reverses the effects of this disorder.

Topics: Abdomen; Aged; Aged, 80 and over; Ascorbic Acid; Ascorbic Acid Deficiency; Cardiovascular Surgical Procedures; Diagnosis, Differential; Female; Hemorrhage; Humans; Male; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Retrospective Studies

Oxidative damage and inflammation are believed to play an important role in postoperative complications after cardiopulmonary bypass. During bypass, a prime solution with a high antioxidant capacity may reduce the oxidative damage and inflammation. We investigated total antioxidant capacity and individual scavengers during the preparation of 2 different prime solutions.. The prime solutions were prepared with either pasteurized human albumin or fresh frozen plasma. The total antioxidant capacity was measured with the total radical antioxidant parameter assay and with the ferric-reducing ability of plasma assay. The individual scavengers vitamin C, sulfhydryl groups, uric acid, and total protein were measured before, during, and after the prime preparation. Malondialdehyde was measured as a parameter for lipid peroxidation.. Neither prime solution showed a total radical antioxidant parameter value. The ferric-reducing ability of plasma value of prime solutions was lower than that of undiluted human albumin or fresh frozen plasma. Addition of mannitol did not increase the ferric-reducing ability of plasma value. Vitamin C was only found in the fresh frozen plasma prime. Both prime solutions contained sulfhydryl groups and uric acid in low concentrations. During ultrafiltration, low-molecular-weight antioxidants were lost into the ultrafiltrate.. We showed that prime solutions based on either albumin or fresh frozen plasma had very low antioxidant capacity and that ultrafiltration of the prime solution further lowers this capacity. A prime solution with a low antioxidant capacity may increase oxidative stress in neonates undergoing cardiopulmonary bypass.

Topics: Albumins; Antioxidants; Ascorbic Acid; Blood Proteins; Cardioplegic Solutions; Cardiopulmonary Bypass; Chemistry, Pharmaceutical; Drug Evaluation, Preclinical; Free Radical Scavengers; Humans; Infant, Newborn; Lipid Peroxidation; Malondialdehyde; Morbidity; Oxidative Stress; Plasma; Postoperative Complications; Treatment Outcome; Ultrafiltration; Uric Acid

The parameters of the activity of the antioxidative system (AOS) were studied in 85 patients aged 1 to 14 years who had nephroblastoma in the immediate postoperative period. They were compared with those in healthy children. To prevent AOS failure, Group 1 patients with nephroblastoma received ascorbic acid (AA) in a dose of 15 mg. Group 2 patients took a larger dose (25-30 mg) in combination with alpha-tocopherol. It was ascertained that the small dose of AA did not prevent AOS failure in the postoperative period while its larger doses prevented significant manifestations of antioxidative protective deficit, by reducing the incidence and severity of postoperative trophic complications.

Topics: Adolescent; Antioxidants; Ascorbic Acid; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Kidney Neoplasms; Lipid Peroxidation; Nephrectomy; Postoperative Complications; Postoperative Period; Prognosis; Time Factors; Vitamin E; Wilms Tumor

Topics: Adult; Anastomosis, Surgical; Ascorbic Acid; Calcinosis; Combined Modality Therapy; Female; Humans; Hydrogen-Ion Concentration; Ileum; Kidney Diseases; Kidney Pelvis; Kidney Transplantation; Postoperative Complications; Pyelitis

It has been reported that systemic and local redox state may have an important role in the functional and organic changes characterizing the process of vascular response to injury. Carotid endarterectomy to remove atherosclerotic plaque is followed by a long lasting healing and remodeling process that can be carefully followed over time with noninvasive ultrasonography. Plasma vitamin C concentration and native LDL (n-LDL) content in lipid peroxides, vitamin E, beta-carotene, and lycopene as well as LDL susceptibility to peroxidation were assessed in 45 patients undergoing elective endarterectomy for internal carotid stenosis, at baseline, 24 hours, 3 and 15 days, and 1 month after surgery. Serial duplex scans were performed in all patients postoperatively and 3, 6, and 12 months. The changes in far wall thickness (FW) and % renarrowing from postoperatively to 12 months were used as remodeling indices. Plasma antioxidant vitamins and lag-phase showed a sharp and significant decrease during the first 24-hours after surgery remaining unchanged until the third day, whereas, an opposite trend was evidenced for n-LDL content in lipid peroxides and serum ceruloplasmin. After the third day all the parameters returned progressively to baseline within one month from endarterectomy. Interestingly, the n-LDL lipid peroxide content, the serum ceruloplasmin and the plasma vitamin C concentration, measured at 24 and 3 days from surgery, were significantly associated to the change in % renarrowing from postoperatively to 12 months. The higher the LDL content in lipid peroxides, the higher the serum level of ceruloplasmin, the lower the plasma content in vitamin C and the higher the % of vessel renarrowing. In conclusion, carotid endarterectomy with atherosclerotic plaque removal is associated with an acute and prolonged increase in systemic oxidative stress that influences vascular healing and late luminal loss.

Topics: Aged; Ascorbic Acid; beta Carotene; Carotenoids; Carotid Artery, Internal; Carotid Stenosis; Ceruloplasmin; Cholesterol, LDL; Elective Surgical Procedures; Endarterectomy, Carotid; Female; Follow-Up Studies; Humans; Lycopene; Male; Middle Aged; Multivariate Analysis; Oxidative Stress; Postoperative Complications; Thiobarbituric Acid Reactive Substances; Time Factors; Ultrasonography; Vitamin E; Wound Healing

There are a number of differential diagnoses for crystal deposits in the cornea. With the presence of a corneal epithelial defect, the differential diagnosis can be narrowed down to either infective causes or deposits from topical medications. This report describes a case of crystal deposits in the cornea from the use of Vitamin C eye drops.

Topics: Ascorbic Acid; Cataract Extraction; Corneal Diseases; Crystallization; Epithelium, Corneal; Female; Humans; Lenses, Intraocular; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Vitrectomy

We will report on our preliminary findings using microdialysis to monitor three patients in intensive care with either severe head injury (SHI) or severe subarachnoid hemorrhage (SAH) for up to 72 hours. In addition, basal levels in uninjured brain were assessed during an extra-intracranial bypass operation. Samples were collected hourly or half-hourly (flow rate 2 microliters/min, perfusion medium 0.9% saline). Parameters measured were the antioxidants ascorbic acid, uric acid, glutathione and cysteine. In 2 patients, the pH of the dialysate (pHD) was also measured on-line with a specially constructed flow-through meter, and glucose and lactate levels were assessed in the dialysate. In patient 1 (SHI), there was practically no cerebral perfusion pressure because of high ICP; cysteine and lactate levels were very high and glucose not measurable. In patient 2 (SAH) a hypoxic episode was accompanied by increased uric acid and decreased glucose. In patient 3 (SHI), the pHD reflected normalisation of blood gases after hyperventilation. Results indicate that parameters are in the range known from experimental studies, and can be correlated with clinical situations. The pHD as valuable indicator of metabolic changes is also feasible bedside.

Topics: Acid-Base Equilibrium; Adult; Ascorbic Acid; Blood Glucose; Blood-Brain Barrier; Brain Edema; Brain Injuries; Cerebrospinal Fluid Shunts; Craniotomy; Critical Care; Cysteine; Energy Metabolism; Female; Glutathione; Humans; Hydrogen-Ion Concentration; Hypoxia, Brain; Intracranial Pressure; Lactates; Lactic Acid; Male; Microdialysis; Middle Aged; Monitoring, Physiologic; Online Systems; Postoperative Complications; Signal Processing, Computer-Assisted; Subarachnoid Hemorrhage; Uric Acid

The authors present their results regarding the use of a buffered solution of glycerol 30%-sodium ascorbate 20% (GLIAS) for the treatment of brain oedema and intracranial hypertension. GLIAS was perfused intravenously in 80 patients with several types of brain oedema. In every patients serum and urinary osmolarity, diuresis, main blood and urine parameters, and ICP were monitored. Following GLIAS infusion an increase in plasma osmolarity was observed, changing the average basal value plus 13.4% after 15 min., 10.5% after 30'. At the same time there was a reduction of ICP and improvement in cerebral compliance. In each case there was a decrease in intracranial hypertension and brain oedema without significant collateral effects.

Topics: Adolescent; Adult; Aged; Ascorbic Acid; Brain Edema; Brain Injuries; Brain Neoplasms; Buffers; Cerebral Hemorrhage; Child; Dose-Response Relationship, Drug; Female; Glycerol; Humans; Hypertonic Solutions; Infusions, Intravenous; Intracranial Aneurysm; Intracranial Pressure; Male; Middle Aged; Postoperative Complications; Pseudotumor Cerebri

Trauma and anaesthetics are responsible for local and general change in the organism. The characteristic changes in metabolism are caused by hormones. In addition, the increased glycogenolysis, gluconeogenesis, proteolysis and lipolysis are characteristic of this catabolic metabolism. Three groups (injured patients, patients with pulmonary disease, multiple trauma patients) showed an elevated lipid peroxidation as indicated by increased formation of TBA-reactive substances in the post-trauma or after surgery phase. The production of free radicals is supported by several stress factors. In this connection, the state of metabolism of the patients, several anaesthetics and the artificial respiration is very important. Enzymatic protecting systems (SOD, GSH-Px, Catalase) react to oxidative stress by positive adaptation. The non-enzymatic antioxidative systems (tocopherol, ascorbic acid, selen) are diminished, indicating an increased requirement.

Topics: Ascorbic Acid; Catalase; Glutathione Peroxidase; Humans; Lipid Peroxidation; Lung Neoplasms; Male; Malondialdehyde; Multiple Trauma; Postoperative Complications; Superoxide Dismutase; Vitamin E; Wounds and Injuries

We studied prospectively the effects of 2% hydroxypropylmethylcellulose (HPMC), instilled in to the anterior chamber during extracapsular cataract extraction with posterior chamber intraocular lens implantation in 122 patients. Significant pressure rise was noted at 12 and 24 hours post-operatively when HPMC was not removed at the end of surgery. This was prevented by washing HPMC from the anterior chamber at the end of surgery, or by using either acetazolamide or a combination of oxyphenbutazone and vitamin C without washing HPMC. There was no difference in intraocular inflammation between controls and the HPMC groups. The group receiving combined oxyphenbutazone and vitamin C had the least, the differences between these two groups being sufficient.

Topics: Acetazolamide; Anterior Chamber; Ascorbic Acid; Cataract Extraction; Female; Humans; Hypromellose Derivatives; Inflammation; Intraocular Pressure; Lenses, Intraocular; Male; Methylcellulose; Ophthalmic Solutions; Oxyphenbutazone; Postoperative Complications; Prospective Studies; Time Factors

In the last few years, a great deal of attention has been paid to the hypothetical relationship between high nitrate intake, N-nitroso-compounds and gastric cancer. This long term study deals with the effect of nitrate and ascorbic acid contained in drinking water on the development of cancer in operated stomachs of rats without additional application of a carcinogen (tumor model). A total of 147 F1-Hybrids of WELS/Fohm X BD IX--rats were subjected to stomach operation (Gastroenterostomia antecolica anterior, truncular vagotomy and pyloroplasty). Carcinomas in stomach occurred within 33 weeks (post operationem). The surgical procedures altered the gastric flora, resulting in an increase and predominance of nitrate-reducing bacteria. The maximal tumor rate (10 of 13 rats) occurred in rats with gastroenterostomy and additional nitrate exposition. It may be possible, the nitrate is a precursor of gastric carcinogenesis. But we could not give any significant evidence of this fact. The addition of ascorbic acid to the drinking water lead to a suppression of the development of tumors. Our experience with the tumor model "operated stomach" underline the multifactorial genesis of stomach cancer in rats.

Topics: Animals; Ascorbic Acid; Drinking; Female; Gastroenterostomy; Male; Nitrates; Postoperative Complications; Pylorus; Rats; Stomach; Stomach Neoplasms; Vagotomy; Water Supply

Topics: Ascorbic Acid; Cardiac Surgical Procedures; Esophageal Stenosis; Female; Humans; Middle Aged; Postoperative Complications; Tablets; Ulcer

Nutritional cofactors play a major role in the wound-healing process. Deficiencies of specific nutrients, especially proteins, vitamins, and minerals, may significantly impair the healing process. The recognition of deficits and understanding of methods of repletion are a critical part of modern surgical practice.

Topics: Amino Acids; Animals; Ascorbic Acid; Collagen; Dietary Proteins; Humans; Minerals; Nutritional Physiological Phenomena; Parenteral Nutrition, Total; Postoperative Complications; Protein Deficiency; Rats; Serum Albumin; Surgical Wound Dehiscence; Surgical Wound Infection; Tensile Strength; Trace Elements; Transferrin; Vitamins; Wound Healing; Zinc

The postoperative ascorbic acid requirements of 63 surgical patients were assessed by measurement of buffy layer leucocyte ascorbic acid and the ascorbic acid content of white blood cells. There was a significant reduction in ascorbic acid levels following surgery. The postoperative changes were unrelated to the extent of surgical trauma or the volume of blood transfused during surgery but there was a significant correlation between postoperative ascorbic acid measurements and white blood cell counts. It appears that postoperative leucocytosis and release by the bone marrow of white blood cells with a low ascorbic acid content may partly account for the postoperative changes in buffy layer and white blood cell ascorbic acid measurements. However, surgical operations were followed by an authentic increase in ascorbic acid requirements, and there was a 42 per cent reduction in circulating white blood cell ascorbic acid levels on the third postoperative day. The findings of this study create an argument for the use of ascorbic acid supplements in surgical patients although it is unlikely that postoperative changes in leucocyte ascorbic acid have pathologic significance in wound repair.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Blood Cell Count; Erythrocyte Count; Humans; Leukocyte Count; Leukocytes; Nutritional Requirements; Postoperative Complications; Postoperative Period; Surgical Procedures, Operative

Topics: Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Cataract Extraction; Female; Humans; Hyphema; Postoperative Complications; Retinal Hemorrhage

Topics: Adolescent; Adult; Ascorbic Acid; Humans; Pain, Postoperative; Postoperative Complications; Tooth, Impacted; Wound Healing

Topics: Arthroplasty; Ascorbic Acid; Aspirin; Female; Hip; Hip Joint; Humans; Joint Prosthesis; Male; Middle Aged; Postoperative Complications; Prospective Studies; Thromboembolism

The complications of emergency surgery for acute upper gastro-intestinal haemorrhage in 95 patients were compared with those of surgery for non-bleeding benign peptic ulceration in 380 patients. There was a significantly higher number of senior surgeons performing emergency surgery for haemorrhage. There was a significantly higher mortality (10-5 %), wound dehiscence rate (12-6 %) and wound complication rate with re-bleeding (33-7 %) in the post-haemorrhage patients compared with the non-bleeding group (1-3, 1-8 and 11-6 % respectively). There was no significant difference in the incidence of chest infection in the two groups. Mortality and morbidity after haemorrhage were correlated directly with the amount of blood transfused before surgery. Rats were used to study the effect of the removal of 13 % of the blood volume, and its restoration after varying time intervals, upon subsequent wound healing. Abdominal wounds were tested at 7 days for breaking and bursting strength. There was no difference between the wound strength of the control animals and animals which had been bled for 4 minutes before wounding. A significant reduction of wound strength occurred in animals which had been bled for 30-60 minutes before wounding. Prolonged blood loss was associated with deficient wound healing even if blood loss was restored before the wounds were made. Stored blood may be deficient in a factor which is necessary for normal wound healing.

Topics: Adolescent; Adult; Age Factors; Aged; Animals; Ascorbic Acid; Blood Pressure; Blood Transfusion; Blood Volume; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Rats; Shock, Hemorrhagic; Surgical Wound Dehiscence; Wound Healing

Topics: Adult; Ascorbic Acid; Female; Humans; Kidney Transplantation; Lipids; Male; Middle Aged; Postoperative Complications; Time Factors; Transplantation, Homologous; Vitamin A; Vitamin E

Topics: Acidosis; Adrenocortical Hyperfunction; Ascorbic Acid; Ascorbic Acid Deficiency; Peptic Ulcer; Postoperative Care; Postoperative Complications; Preoperative Care

Topics: Ascorbic Acid; Fructose; Glucose; Humans; Magnesium; Parenteral Nutrition; Phosphates; Postoperative Complications; Potassium; Shock; Sodium; Sorbitol; Vitamin A; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins; Xylitol; Zinc

Topics: Adolescent; Adult; Alkaline Phosphatase; Ascorbic Acid; Aspartate Aminotransferases; Bilirubin; Carotenoids; Cholesterol; Drainage; Female; Folic Acid; Glucose Tolerance Test; Hepatitis; Humans; Ileum; Intestinal Absorption; Intestinal Obstruction; Intestine, Small; Jejunum; Lipids; Male; Middle Aged; Necrosis; Obesity; Postoperative Complications; Surgical Wound Infection; Thrombophlebitis; Triglycerides; Uric Acid; Vitamin A; Vitamin B 12; Vitamin E; Xylose

Topics: Adrenal Glands; Alkaline Phosphatase; Animals; Ascorbic Acid; DNA; Glycosaminoglycans; Hydroxysteroid Dehydrogenases; Pineal Gland; Pituitary-Adrenal Function Tests; Postoperative Complications; Rats; RNA

Topics: Adult; Ascorbic Acid; Blood Cell Count; Blood Glucose; Blood Pressure; Body Weight; Diet Therapy; Feces; Female; Folic Acid; Gastric Acidity Determination; Humans; Ileum; Interpersonal Relations; Iron; Jejunum; Liver Function Tests; Malabsorption Syndromes; Methods; Middle Aged; Obesity; Postoperative Complications; Psychology; Water-Electrolyte Balance

Topics: Adolescent; Adult; Aged; Ascorbic Acid; Child; Copper; Female; Humans; Hydrogen Peroxide; Male; Middle Aged; Postoperative Complications; Sputum; Sulfates; Thoracic Diseases

Topics: Adult; Ascorbic Acid; Electrocoagulation; Female; Humans; Macula Lutea; Male; Middle Aged; Postoperative Complications; Prednisone; Retinal Detachment; Retinitis; Vision Tests; Vitamin B Complex

Topics: Adenoids; Ascorbic Acid; Child; Cyclopropanes; Ethyl Chloride; Ethyl Ethers; Halothane; Humans; Oral Hemorrhage; Postoperative Complications; Preoperative Care; Seasons; Tonsillectomy; Trichloroethylene; Vitamin K

Topics: Ascorbic Acid; Audiometry; Deafness; Diphenhydramine; Drug Therapy; Hearing Disorders; Histamine; Humans; Hydrocortisone; Meprobamate; Niacin; Postoperative Complications; Procaine; Stapes Surgery

Topics: Ascorbic Acid; Capillaries; Cataract Extraction; Drug Therapy; Eye Diseases; Flavonoids; Hemorrhage; Humans; Hyphema; Postoperative Complications; Postoperative Period; Preventive Medicine

Topics: Ascorbic Acid; Bronchial Fistula; Bronchiectasis; Empyema; Empyema, Pleural; Humans; Lung Abscess; Lung Neoplasms; Oxytetracycline; Penicillins; Pneumonectomy; Postoperative Complications; Pulmonary Fibrosis; Punctures; Streptomycin; Thiamine