Abstract
Background: To investigate the changes in plasma levels of endothelin (ET), nitric oxide (NO), prostacyclin (PGI2) and thromboxane A2 (TXA2) in patients undergoing abdominal operation. Materials and Methods: Thirty cases of abdominal surgery (14 males, 16 females; mean age 48 ± 11 years, ranging from 24 to 70) were prospectively recruited: Twenty-four cases of cholelithiasis and cholecystitis, 2 cases of peptic ulcer and 4 cases of portal vein hypertension. At five different time points (1-3 days after hospitalization (T1), at surgery beginning, after anesthesia (T2) and at the first (T3), third (T4) and fifth day (T5) after surgery), plasma levels of ET-1, NO2-, NO3-, 6-keto-PGF1α and thromboxane B2 (TXB2), the latter two being stable metabolites of PGI2 and TXA2 respectively, were measured. Results: ET-1 levels increased significantly after anesthesia and surgery (T1 = 69.2 ± 10.7 vs. T2 = 82.4 ± 14.7 vs. T3 = 96.6 ± 22.8 pg/ml, p 2 levels before surgery were significantly lower than that after (T2 = 67.5 ± 52.7 vs. T3 = 157.6 ± 21.8 pg/ml, p 1α were significantly higher than that after anesthesia and surgery (T1 = 180.5 ± 17.8 vs. T2 = 132.1 ± 32.6 vs. T3 = 110.9 ± 31.9 pg/ml, p 2) increased significantly after surgery, while vasodilatory factors (NO and PGI2) decreased significantly after operation. Imbalance in vasoactive factors encourages hypercoagulability and then may play a role in the pathobiology of post-surgery complications, such as deep venous thrombosis (DVT).
Highlights
Patients undergoing abdominal surgery under general anesthesia present substantial risks of post-surgery venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) [1] [2]
It has been well established that surgery is one of the most common risk factors for VTE [6] [7] and that abdominal surgery leads to a hypercoagulation state [8], little is known about the molecular mechanisms of VET after abdominal surgery and about temporal changes in vasoactive factors before and after surgery
ET-1 plasma levels significantly increased at the beginning of surgery and after operation (T1 = 69.2 ± 10.7 vs. T2 = 82.4 ± 14.7 vs. T3 = 96.6 ± 22.8 pg/ml, p < 0.05), reaching its highest value at the 3rd day after operation (T4 = 105.3 ± 26.4 pg/ml), with ET-1 levels 1.5-fold higher than before surgery (p < 0.05)
Summary
Patients undergoing abdominal surgery under general anesthesia present substantial risks of post-surgery venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) [1] [2]. It has been shown that vascular endothelial cells (VEC) are a barrier between blood and surrounding tissues, and have important secreting functions They can secrete vasoactive factors, such as endothelin-1 (ET-1), nitric oxide (NO) and protacyclin (PGI2), to regulate vascular tonus and to inhibit platelet aggregation, playing an important role in different cardiovascular diseases [4]. The plateletderived thromboxane A2 (TXA2) is a potent agonist of platelet aggregation and a potent vascular smooth muscles cells constricting agent [5] Imbalanced ratios of these factors may result in VTE after abdominal surgeries. Imbalance in vasoactive factors encourages hypercoagulability and may play a role in the pathobiology of post-surgery complications, such as deep venous thrombosis (DVT)
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