Abstract
BackgroundThis study aimed to reveal the appropriate timing for the intravenous administration of flurbiprofen axetil for preventing mesenteric traction syndrome (MTS), caused by prostacyclin release.MethodsIn this prospective, randomized, clinical study, forty-five patients who were undergoing elective surgery for colorectal cancer via laparotomy were enrolled. Patients were randomly divided into 3 groups: a preoperative group (n = 16) receiving flurbiprofen axetil directly before surgery; a post-MTS group (n = 14) receiving following MTS onset; and a control group (n = 15) who were not administered flurbiprofen axetil. 6-keto-PGF1α, a stable metabolite of prostacyclin, levels were measured and mean blood pressures were recorded.ResultsIn the preoperative group, 6-keto-PGF1α levels did not increase, blood pressure levels did not decrease, and no facial flushing was observed. In both the post-MTS and control groups, 6-keto-PGF1α levels increased markedly after mesenteric traction and blood pressure decreased significantly. The post-MTS group exhibited a faster decreasing trend in 6-keto-PGF1α levels and quick restore of the mean blood pressure, and the use of vasopressors and phenylephrine were lower than that in the control group.ConclusionsEven therapeutic administration of flurbiprofen axetil after the onset of MTS has also effects on MTS by suppressing prostacyclin production.Trial registrationClinical trial number: UMIN000009111. (Registered 14 October 2012)
Highlights
This study aimed to reveal the appropriate timing for the intravenous administration of flurbiprofen axetil for preventing mesenteric traction syndrome (MTS), caused by prostacyclin release
Because MTS is caused by the synthesis and secretion of prostacyclin, its onset can be confirmed by a rise in 6-keto-prostaglandin F1α (6-keto-PGF1α) levels, which is a stable end-product of prostacyclin metabolis [4, 5]
Whereas the definitive diagnosis of MTS requires the measurement of the level of 6-keto-PGF1α, Takahashi et al BMC Surgery (2017) 17:90 the clinical diagnosis is based on the occurrence of facial flushing
Summary
This study aimed to reveal the appropriate timing for the intravenous administration of flurbiprofen axetil for preventing mesenteric traction syndrome (MTS), caused by prostacyclin release. Intraoperative bleeding and sympathetic blocks in anesthesia are among the causes of hemodynamic changes during surgery. They can be caused by the surgical procedure itself, such as that involving traction of the mesentery. Mesenteric traction leads to increased shear stress on Hemodynamic changes occurring due to mesenteric traction are characterized by sudden tachycardia, hypotension, and facial flushing. This phenomenon is called mesenteric traction syndrome (MTS) [6]. Whereas the definitive diagnosis of MTS requires the measurement of the level of 6-keto-PGF1α, Takahashi et al BMC Surgery (2017) 17:90 the clinical diagnosis is based on the occurrence of facial flushing
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