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Selective Diaphragm Muscle Weakness After Contractile Inactivity During Thoracic Surgery.
MedLine Citation:
PMID:  21975323     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE:: Postoperative pulmonary complications are significant contributors to morbidity in patients who have undergone upper abdominal, thoracic, or cardiac surgery. The pathophysiology of these complications might involve postoperative inspiratory muscle weakness. The nature of postoperative inspiratory muscle weakness is unknown. OBJECTIVE:: To investigate the effect of surgery on the functioning of the diaphragm, the main muscle of inspiration. METHODS:: Serial biopsies from the diaphragm and the latissimus dorsi muscle were obtained from 6 patients during thoracotomy for resection of a tumor in the right lung. Biopsies were taken as soon as the diaphragm had been exposed (t0) and again after 2 hours (t2). The contractile performance of demembranated muscle fibers, as well as fiber morphology and markers for proteolysis, was determined. RESULTS:: In all patients, the force-generating capacity of diaphragm muscle fibers at t2 was significantly reduced (∼35%) compared with that at t0, with a more pronounced force loss in type 2 fibers compared with type 1 fibers. Diaphragm weakness was not part of a generalized muscle weakness as contractile performance of latissimus dorsi fibers was preserved at t2. Diaphragm fiber size and myofibrillar structure were not different at t2 compared with t0, but myosin heavy chain type 2 was significantly reduced at t2 and MuRF-1 mRNA and protein levels were elevated at t2. CONCLUSIONS:: Only 2 hours of thoracic surgery causes marked, and selective, diaphragm muscle fiber weakness.
Authors:
Willem N Welvaart; M A Paul; Ger J M Stienen; Hieronymus W H van Hees; Stephan A Loer; Ra Bouwman; Hans Niessen; Frances S de Man; Christian C Witt; Henk Granzier; Anton Vonk-Noordegraaf; Coen A C Ottenheijm
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-4
Journal Detail:
Title:  Annals of surgery     Volume:  -     ISSN:  1528-1140     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Departments of *Surgery †Physiology ‡Anesthesiology §Pathology and Cardiac Surgery ∥Pulmonology, VU University Medical Center/Institute for Cardiovascular Research ¶Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center #Department of Surgery, Rivierenland hospital, The Netherlands **Department of Anesthesiology and Intensive Care, Universitatsklinikum Mannheim, University of Heidelberg, Germany ††Department of Physiology, University of Arizona, Tucson.
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