| Intrapulmonary clotting and fibrinolysis during abdominal aortic aneurysm surgery. | |
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MedLine Citation:
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PMID: 507973 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Intravascular clotting and fibrinolysis (C and F) are events which often accompany major surgical trauma. Their role in inducing cardiopulmonary failure is debated and prompted this study of 13 patients undergoing elective AAA. Following intubation, anesthesia and pressure breathing fibrinolytic activity (FA) in arterial blood exceeded that in mixed venous blood (p < 0.001) indicating pulmonary secretion of proteolytic activity. Fibrinogen, plasminogen and fibrin degradation products (FDPs) were normal. During surgery, fibrinogen and plasminogen fell (p < 0.001) while nonplasmin mediated FA and FDPs rose (p < .001). Despite heparinization (5000 U IV) aortic clamping (avg 56 min) led to evidence of C and F within the lungs. Arterial fibrinogen was 33.2 mg/ml lower than mixed venous blood (p < 0.01) and plasminogen was 0.47 Sherry units lower (p < 0.001). Soluble fibrin monomer appeared in arterial blood (p < 0.01). At the same time nonplasmin mediated FA was consumed within the lungs (p < 0.01) and FDPs were produced (44.6 microg/ml higher in arterial blood, p < 0.001). Similar changes were noted after aortic declamping. The transient 5.3 ml/cm H(2)0 fall in dynamic compliance was unrelated to C and F. Pulmonary vascular resistance and arterial pressure were unchanged. During wound closure intrapulmonary C and F ceased. Postoperatively (6 h), the physiologic shunt of 15.1% was similar to tbe preoperative value of 13.3%. All C and F factors returned to normal except FDPs which remained elevated. An average of 0.2 U blood was given prior to aortic clamping and 3.1 U during clamping. Neither the volume nor the type of blood (7 patients received washed RBCs) influenced pulmonary C and F. The results show that pressure breathing will alter pulmonary metabolism from clearance to secretion of fibrinolytic activity. Surgery leads to systemic C and F while intrapulmonary C and F is triggered by aortic clamping despite IV heparin. Delayed functional consequences of C and F are possible. Immediate postoperative effects are not apparent. |
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Authors:
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G A McLoughlin; G A Grindlinger; J Manny; C R Valeri; B Lipinski; J A Mannick; H B Hechtman |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Annals of surgery Volume: 190 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 1979 Nov |
Date Detail:
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Created Date: 1980-01-19 Completed Date: 1980-01-19 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 623-30 Citation Subset: AIM; IM |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aorta, Abdominal
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surgery Aortic Aneurysm / surgery* Disseminated Intravascular Coagulation / etiology* Fibrin / analysis Fibrin Fibrinogen Degradation Products / analysis Fibrinogen / analysis Fibrinolysis* Hemodynamics Humans Intraoperative Period Lung / blood supply* Plasminogen / analysis Pulmonary Circulation Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Fibrinogen Degradation Products; 9001-31-4/Fibrin; 9001-32-5/Fibrinogen; 9001-91-6/Plasminogen |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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