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Intraperitoneal glycerol levels and lactate/pyruvate ratio: early markers of postoperative complications
Örebro University, School of Health and Medical Sciences. Department of Surgery. (Kärlkirurgen/Microdialys)
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
2011 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 46, no 7-8, p. 913-919Article in journal (Refereed) Published
Abstract [en]

Objective: We have previously presented microdialysis findings of early intraperitoneal (ip) metabolic disturbances, mainly an increased lactate/pyruvate (l/p) ratio, in surgical patients developing postoperative complications. The aim of the present study was to investigate ip glycerol and l/p ratio after major surgery with and without complications.

Material and methods :Sixty patients were followed with microdialysis for 48 h after major abdominal surgery, 44 patients without postoperative complications and 16 patients with major surgical complications. Intraperitoneal and subcutaneous (sc) measurements of glycerol, lactate, pyruvate and glucose were performed, and the l/p ratio was calculated.

Results: Intraperitoneal glycerol was significantly lower in the complication group compared with the control group (64 vs. 94.6 μM; p = 0.0015), while the ip l/p ratio was significantly higher in the complication group compared with the control group (13.7 vs. 11.1; p = 0.0073).

Conclusions: In this study, ip glycerol levels were lower and ip l/p ratio was higher in the immediate postoperative period in a group of patients with complications. These results might indicate early ip disturbances in fat and carbohydrate metabolism in patients who later developed symptoms of postoperative major complications.

Place, publisher, year, edition, pages
Informa Healthcare, 2011. Vol. 46, no 7-8, p. 913-919
Keywords [en]
Glucose, glycerol, intraperitoneal, lactate, lactate/pyruvate ratio, microdialysis, postoperative complications
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-15172DOI: 10.3109/00365521.2011.568519ISI: 000292646800021PubMedID: 21443418Scopus ID: 2-s2.0-79960245414OAI: oai:DiVA.org:oru-15172DiVA, id: diva2:407890
Projects
Intraabdominal metabolism/microdialysisAvailable from: 2011-04-04 Created: 2011-04-01 Last updated: 2018-02-20Bibliographically approved
In thesis
1. Early detection of major surgical postoperative complications evaluated by microdialysis
Open this publication in new window or tab >>Early detection of major surgical postoperative complications evaluated by microdialysis
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Major abdominal surgery may be followed by postoperative complications, especially in the elderly and patients with co morbidities as diabetes mellitus and obesity. Some of the most feared complications as anastomotic leakage, abdominal infections, abdominal compartment syndrome (ACS) and intestinal ischemia can lead to sepsis, systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) with high morbidity and mortality. This thesis evaluates intraperitoneal microdialysis (IPM) as a method for early detection of surgical complications. IPM measures extracellular metabolites as lactate, pyruvate, glycerol and glucose. The lactate/pyruvate (l/p) ratio describes the current relationship between aerobic and anaerobic metabolism. Glycerol is a degradation product of lipolysis from fat and a part of the cell membrane and released when cell injury occurs. In Paper I, evaluation of IPM in patients with and without diabetes mellitus and obesity during 48 hours after abdominal surgery did not show any difference in l/p ratio and glycerol levels compared to a control group. Paper II investigated the first two days after abdominal surgery in patients with major complications using IPM. L/p ratio was higher and glycerol was lower. Paper III used IPM in the immediate postoperative period in patients after endovascular repair for ruptured abdominal aortic aneurysm (rEVAR). Patients who required decompression due to intraabdominal hypertension (IAH) with organ failure had higher l/p ratio and glycerol. Paper IV investigated the effects of Aortic Balloon Occlusion (ABO) and Superior Mesenteric Artery (SMA) occlusion for one hour followed by three hours reperfusion in an animal model. ABO had a pronounced effect on the hemodynamic state. I.p l/p ratio increased during ischemia and decreased on reperfusion while glycerol increased on reperfusion and the effect was less pronounced in the SMA group. In conclusion, IPM monitoring of l/p ratio and glycerol indicates serious postoperative complications at an early stage. The l/p ratio increases or is continuously high while glycerol seems to have a more complex pattern. Diabetes and obesity do not influence the results.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 64
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 89
Keywords
aortic occlusion balloon, anastomotic leakage, glycerol, intraabdominal hypertension, intraperitoneal microdialysis, intestinal ischemia, intraabdominal metabolism, lactate/pyruvate ratio, postoperative complications, ruptured abdominal aortic anerusym
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-28662 (URN)978-91-7668-939-4 (ISBN)
Public defence
2013-06-07, Wilandersalen, Universitetssjukhuset, Södra Grev Rosengatan 18, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2017-10-18Bibliographically approved

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Hörer, Tal M.

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