interleukin-8 and Blood-Loss--Surgical

The inflammatory response triggered by transfusion is implicated in the pathophysiology of transfusion-related immunomodulation. The authors hypothesized that two distinctive autotransfusion methods, acute normovolemic hemodilution (ANH) and preoperative donation (PD), have different influences on both inflammatory mediator generation during storage and the inflammatory response after a transfusion. The purpose of this study was to compare the plasma concentrations of neutrophil elastase (NE), interleukin (IL)-6, IL-8, and IL-10 in patients who underwent either of these two autologous transfusion methods.. With institutional review board approval, the plasma concentrations of the above inflammatory mediators were determined in 23 patients with ANH and 8 patients with PD at the following time points: after anesthetic induction, at the end of the operation, and the morning of postoperative day 1. The concentrations of these inflammatory mediators were also measured in the donated blood obtained by either ANH or PD before retransfusion.. The mean storage durations were 3.7 h and 6.1 days for ANH and PD, respectively. Higher concentrations of NE and IL-10 were detected in the PD blood than in the ANH blood. Long duration of storage and/or low temperature may have been responsible for the increased NE and IL-10 concentrations in the PD blood. However, the difference between the two groups in the extent of increased plasma concentrations of these inflammatory mediators was not statistically significant.. Inflammatory mediators were significantly increased in PD blood during storage compared to the blood obtained by ANH. However, their effects on the inflammatory response elicited in the recipients were not significantly different.

Topics: Adult; Blood Loss, Surgical; Blood Transfusion, Autologous; Blood Volume; Female; Hemodilution; Hemoglobins; Humans; Inflammation; Interleukin-10; Interleukin-6; Interleukin-8; Leukocyte Count; Leukocyte Elastase; Male; Middle Aged; Preoperative Period; Prospective Studies

Cardiopulmonary bypass causes inflammatory reactions leading to organ dysfunction postoperatively. This study was undertaken to determine whether using patients' own lungs as oxygenator in a bilateral circuit (Drew-Anderson Technique) could reduce systemic inflammatory response to cardiopulmonary bypass, improving patients clinical outcome following coronary artery bypass grafting.. A prospective randomized controlled trial involving 30 patients, divided in two groups of 15 patients each, undergoing elective coronary artery bypass grafting, was undertaken. In the Drew-group bilateral extracorporeal circulation using patient's lung as oxygenator was performed. The other patients served as control group, where standard cardiopulmonary bypass procedure was used.. Pro-inflammatory and anti-inflammatory mediators were measured. Peak concentrations of proinflammatory interleukin-6, interleukin-8, were significantly lower in 15 patients undergoing Drew-Anderson Technique compared with the concentrations measured in 15 patients treated with standard cardiopulmonary bypass technique. Differences in patient recovery were analyzed with respect to time of intubation, blood loss, intrapulmonary shunting, oxygenation, and respiratory index. In patients undergoing uncomplicated coronary artery bypass grafting procedures bilateral extracorporeal circulation using the patients' own lung as oxygenator provided significant biochemical and clinical benefit in comparison to the standard cardiopulmonary bypass procedure.. This prospective randomized clinical study has demonstrated that exclusion of an artificial oxygenator from cardiopulmonary bypass circuit significantly decreases the activation of inflammatory reaction, and that interventions that attenuate this response may result in more favorable clinical outcome.

Topics: Aged; Analysis of Variance; Blood Loss, Surgical; Cardiopulmonary Bypass; Chi-Square Distribution; Coronary Artery Bypass; Elective Surgical Procedures; Extracorporeal Circulation; Humans; Inflammation Mediators; Interleukin-6; Interleukin-8; Intubation, Intratracheal; Lung; Middle Aged; Oxygen; Prospective Studies; Pulmonary Gas Exchange; Respiration; Respiratory Physiological Phenomena; Systemic Inflammatory Response Syndrome; Time Factors; Treatment Outcome

Inflammatory mediators are released in association with intraoperative and postoperative salvage of blood. Whether these mediators (cytokines) participate in the modulation of erythropoiesis or not has been investigated.. Twenty-seven patients who were to undergo total knee replacement surgery were randomly assigned to postoperative blood salvage with either filtered whole blood or washed red cells. Patients with postoperative blood loss <400 mL were considered a control group. The control group did not receive any transfusions. Plasma concentrations of the anaphylatoxin C3a, the C5b-9 terminal complement complex, and the cytokines interleukins 6 and 8, hemoglobin, reticulocytes, and red cell volume fraction in the patients were repeatedly analyzed before and after surgery.. Significantly increased concentrations of interleukin 6 appeared in all three groups, which was interpreted as a response to the surgical trauma. The increase was significantly greater in the group that received filtered whole blood after return of shed blood. The recovery of hemoglobin levels did not differ in the groups.. The transfusion of filtered whole blood leads to the formation of interleukin 6 in the circulation, but postoperative hemoglobin recovery was similar in all groups.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Blood Cell Count; Blood Loss, Surgical; Blood Transfusion, Autologous; Cell Separation; Complement C3a; Complement Membrane Attack Complex; Cytokines; Erythrocyte Transfusion; Female; Filtration; Hemoglobins; Humans; Interleukin-6; Interleukin-8; Male; Middle Aged; Postoperative Hemorrhage; Postoperative Period

To discover the possible effects of methylprednisolone on the systemic inflammatory response during aprotinin treatment.. Randomized, double-blinded study.. University-affiliated heart center.. Fifty-two patients scheduled for elective coronary artery bypass grafting.. In the methylprednisolone group (n = 26), 1 g of methylprednisolone was administered 30 minutes before cardiopulmonary bypass (CPB). The 26 control patients received a placebo instead. High-dose aprotinin was administered to all participants.. After CPB, the concentration of the proinflammatory cytokines, interleukin-6 and interleukin-8, was significantly less in the methylprednisolone group. The anti-inflammatory interleukin-10 concentration was, in contrast, greater. After CPB, PaO2 was greater in the methylprednisolone group (245+/-17 v 195+/-16 mmHg). Dynamic pulmonary compliance was also greater, whereas the alveolar-arterial oxygen difference was less (376+/-17 v 428+/-16 mmHg). On arrival in the intensive care unit, the oxygen delivery index was greater in the methylprednisolone group (62+/-2.7 v 54+/-2.3 mL/min/m2) and the oxygen extraction rate was less (25%+/-0.02% v 30%+/-0.02%). After CPB, the cardiac index was significantly greater in the methylprednisolone group (4.1+/-0.2 v 3.6+/-0.2 L/min/m2). These patients had less blood loss postoperatively (616+/-52 v 833+/-71 mL; p = 0.017) and a greater urine output (8,015+/-542 v 6,417+/-423 mL/24 h; p = 0.024).. The use of methylprednisolone attenuates the systemic inflammatory response during aprotinin treatment and improves clinical outcome parameters.

Topics: Anti-Inflammatory Agents; Aprotinin; Blood Loss, Surgical; Cardiac Output; Coronary Artery Bypass; Double-Blind Method; Elective Surgical Procedures; Glucocorticoids; Hemostatics; Humans; Inflammation Mediators; Interleukin-10; Interleukin-6; Interleukin-8; Lung Compliance; Methylprednisolone; Oxygen; Oxygen Consumption; Placebos; Premedication; Pulmonary Gas Exchange; Systemic Inflammatory Response Syndrome; Treatment Outcome; Urine

Protamine has been used for neutralizing heparin and its dosage is decided by the initial fixed dose of heparin. Adequate protamine neutralization is very important to reduce complications. To attenuate excess reactions, in particular, whole blood heparin concentration during and after cardiopulmonary bypass was measured using Hepcon, and the efficacy of optimal protamine dose in open heart surgery was evaluated. Twenty patients were randomly divided into two comparable groups, P and C. In the C group, heparin was neutralized with an initial fixed dose of protamine, 1.67 mg protamine per milligram total heparin (n = 8). In the P group, protamine dose was determined for residual heparin concentration (n = 12). In the P group, blood heparin concentrations at 60 minutes after the establishment of cardiopulmonary bypass, just after cardiopulmonary bypass and first protamine administration were 2.35 +/- 0.14, 2.31 +/- 0.17 and 0.13 +/- 0.08 U/ml, respectively. Concentrations reached zero with the second protamine administration. The requirement of transfusion (659 +/- 224 vs. 1559 +/- 323 ml, p = 0.0314), pulmonary vascular resistance index just after the protamine administration (190 +/- 22 vs. 286 +/- 18 dyne.s.cm-5.m2, p = 0.0137) and the IL-8 levels (just after protamine: 26.9 +/- 5.1 vs. 43.5 +/- 5.9 pg/ml, p = 0.0499, 12 hours after cardiopulmonary bypass: 37.1 +/- 12.1 vs. 86.8 +/- 20.0, p = 0.0435) in the P group were significantly lower than those in the C group. These data suggested that heparin level monitoring in whole blood may be useful to determine the optimal dose of protamine resulting in the decrease of a requirement of blood components in open heart surgery and attenuating in transient pulmonary hypertension and excess protamine-induced inflammatory reactions.

Topics: Anticoagulants; Blood Loss, Surgical; Blood Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Complement Hemolytic Activity Assay; Heparin; Heparin Antagonists; Humans; Interleukin-8; Middle Aged; Protamines; Pulmonary Artery; Vascular Resistance

To explore effect of short-segment pedicle screw internal fixation combined with hyperbaric oxygen in treating acute spinal fractures and its influence on recovery of spinal nerve function.. A total of 96 patients with acute spinal fracture admitted from February 2017 to March 2020 were divided into combined group and control group, with 48 cases in each group. Both groups were treated with short-segment pedicle screw internal fixation. The combined group was given hyperbaric oxygen after surgery. The operation time, surgical blood loss, incision length and other general operation conditions between two groups were recorded. The differences in spinal morphology and function, Ameraican Spinal Injury Assiciation(ASIA) neurological function grade, serum inflammatory factors and ability of daily living activities were observed before and after surgery.. There was no significant difference in operation time, surgical blood loss, and incision length between combined group and control group(. Short-segment pedicle screw internal fixation combined with hyperbaric oxygen for the treatment of acute spinal fractures is beneficial to the recovery of spinal nerve function after surgery, and has a certain effect on the early improvement of the patients' activities of daily living.

Topics: Activities of Daily Living; Blood Loss, Surgical; Fracture Fixation, Internal; Humans; Hyperbaric Oxygenation; Interleukin-6; Interleukin-8; Lumbar Vertebrae; Oxygen; Pedicle Screws; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Treatment Outcome; Tumor Necrosis Factor-alpha

The anesthesia procedure in tumor-type total knee arthroplasty (TKA) may contribute to systemic inflammatory response. Therefore, we aim to investigate the effectiveness and safety of general and spinal anesthesia in patients with tumor-type TKA.. Twenty-five patients with tumors around the knee undergoing primary unilateral TKA were randomly divided into the general anesthesia group (n = 13) and spinal anesthesia group (n = 12). Knee joint HSS scores and Western Ontario and McMaster University osteoarthritis index (WOMAC osteoarthritis) were recorded before surgery and 12 months after surgery. Visual analogue scale, C-reactive protein (CPR), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8) concentration were measured preoperatively (T0), on the day of the operation (T1), and on the first day (T2) after the operation. Complications in the two groups were recorded.. The operative time, intraoperative blood loss, postoperative drainage, tourniquet time, and complication rate were not significantly different between the general anesthesia and spinal anesthesia groups (all p > 0.05). There were no significant differences in CPR (7.6 ± 3.1, 8.1 ± 4.1, 91.3 ± 24.2 vs. 7.1 ± 2.9, 7.6 ± 3.8, 85.1 ± 19.3 pg/mL, respectively), IL-8 (12.2 ± 6.6, 13.4 ± 7.3, 19.2 ± 10.5 vs. 11.9 ± 5.7, 12.9 ± 8.6, 22.2 ± 12.4 pg/mL, respectively), and TNF-α (2.5 ± 1.7, 2.2 ± 1.9, 2.8 ± 2.1 vs. 2.4 ± 1.3, 2.7 ± 2.1, 2.9 ± 1.6 pg/mL, respectively) between the two groups at T0, T1, and T2 (all p > 0.05). There were no statistical differences in pre- and postoperative HSS knee scores (39.78 ± 11.3, 90.24 ± 15.3 vs. 42.68 ± 12.5, 91.21 ± 16.3) and WOMAC indexes (49.89 ± 7.9, 25.12 ± 6.2 vs. 51.3 ± 8.3, 23.15 ± 5.3) between the two groups (p > 0.05).. General anesthesia and spinal anesthesia in patients with tumor-type TKA had the same effectiveness and safety.

Topics: Aged; Anesthesia, General; Anesthesia, Spinal; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Bone Neoplasms; C-Reactive Protein; Drainage; Female; Humans; Interleukin-8; Knee Joint; Male; Middle Aged; Operative Time; Postoperative Complications; Systemic Inflammatory Response Syndrome; Treatment Outcome; Tumor Necrosis Factor-alpha; Visual Analog Scale

Acute pancreatitis after posterior spinal fusion in children is associated with high intraoperative blood loss. Inflammation, oxidative stress, and pancreatitis markers were assessed during this period. Five of the 17 patients studied developed acute pancreatitis 3-7 days after surgery. Intraoperative blood loss (4850 +/- 2315 vs 1322 +/- 617 ml) and peak tumor necrosis factor alpha levels (15.29 +/- 5.3 vs 8.27 +/- 4.6 pg/ml) in the immediate postoperative period were significantly higher in these five patients than in controls, respectively. No differences were noted in serum interleukin 8, interleukin 6, pancreatis-associated protein, or urine malondialdehyde levels. Urine trypsin-associated peptide, elevated initially in all patients, was significantly higher in the acute pancreatitis group at diagnosis. Length of stay was significantly longer in the acute pancreatitis group. Greater blood loss and peak tumor necrosis factor alpha are associated with subsequent risk of acute pancreatitis, suggesting a role of ischemia-reperfusion injury.

Topics: Acute Disease; Adolescent; Adult; Blood Loss, Surgical; Case-Control Studies; Child; Cytokines; Female; Humans; Interleukin-6; Interleukin-8; Male; Malondialdehyde; Pancreatitis; Pilot Projects; Postoperative Complications; Prospective Studies; Risk Factors; Spinal Fusion; Tumor Necrosis Factor-alpha

We determined the intra- and postoperative plasma concentrations of cytokines (tumor necrosis factor [TNF]-Alpha, interleukin [IL]-1Beta, IL-6, and IL-8) in oral surgery patients with procedures ranging in duration from 20 to 375 min and investigated their relationship to the intensity of the surgical stress over time. No significant differences from baseline levels were observed in the levels of TNF-Alpha, IL-1Beta, and IL-8. By contrast, increased IL-6 levels were noted only on the first postoperative day, when they reached 1500% of the baseline level, after which they decreased to preoperative levels by the third postoperative day and tended to reflect the intensity of surgical stress.

Topics: Adult; Analysis of Variance; Blood Loss, Surgical; Female; Follow-Up Studies; Humans; Interleukin-1; Interleukin-6; Interleukin-8; Interleukins; Intraoperative Period; Male; Middle Aged; Oral Surgical Procedures; Postoperative Period; Stress, Physiological; Time Factors; Tumor Necrosis Factor-alpha

To evaluate the influence of major abdominal surgery on the plasma levels of interleukin-10 (IL-10).. Prospective study.. University hospital.. 10 ASA physical status I and II patients undergoing upper abdominal surgery.. All patients received combined general-epidural anesthesia with isoflurane and nitrous oxide, after insertion of an epidural catheter at T8-T9 dosed with 1.5% lidocaine.. Plasma interleukin-6 (IL-6), interleukin-8 (IL-8), and IL-10 levels were determined with an enzyme-linked immunosorbent assay at preanesthesia, 0, 2, and 4 hours during surgery, and at the end of surgery, followed by sampling on the morning of postoperative days 1 (POD1) and 3 (POD3). Before anesthesia and at 0 hours of surgery, IL-10 was not detected. In all ten patients, the plasma levels of IL-10 showed significant elevations and achieved their maximal value 4 hours after the skin incision (p < 0.05 vs. baseline). The plasma IL-10 levels returned to preanesthesia levels on POD3. The plasma levels of IL-6 and IL-8 also increased in the perioperative period. The peak cytokine levels correlated (r = 0. 915, p = 0.0001 for IL-6 vs. IL-8; r = 0.82, p = 0.025 for IL-6 vs. IL-10; and r = 0.641, p = 0.06 for IL-8 vs. IL-10). The peak plasma IL-10 levels significantly correlated with the amount of intraoperative blood loss (r = 0.69, p < 0.05).. In patients undergoing major abdominal surgery, plasma IL-10 levels were elevated during and after operation. IL-10 may modulate the inflammatory responses in the perioperative period.

Topics: Abdomen; Aged; Alprostadil; Anesthesia, Epidural; Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Local; Blood Loss, Surgical; Dermatologic Surgical Procedures; Female; Follow-Up Studies; Humans; Interleukin-10; Interleukin-6; Interleukin-8; Isoflurane; Lidocaine; Male; Middle Aged; Nitrous Oxide; Prospective Studies; Vasodilator Agents