Insufficiency of plasmatic arginine/homoarginine during the initial postoperative phase among patients with tumors affecting the medulla oblongata heightens the likelihood of neurogenic pulmonary oedema following surgery.
Journal
International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232
Informations de publication
Date de publication:
01 Mar 2024
01 Mar 2024
Historique:
received:
15
07
2023
accepted:
20
11
2023
medline:
18
3
2024
pubmed:
11
12
2023
entrez:
11
12
2023
Statut:
epublish
Résumé
This prospective clinical study aims to investigate the fluctuations of neurotransmitters in peripheral venous blood during the perioperative period and to identify independent predictors for postoperative neurogenic pulmonary oedema (NPE) in patients with medulla oblongata-involved tumours. Peripheral venous blood samples of the enroled patients at seven perioperative time points, as well as their medical records and radiologic data were collected. High-performance liquid chromatography-tandem mass spectrometry was utilized to detect the concentrations of 39 neurotransmitters in these samples. The study applied univariate and multivariate generalized estimating equation (GEE) logistic regression analyses to explore independent predictors of postoperative NPE, and one-way repeated-measures ANOVA to compare the concentrations of the same neurotransmitter at different perioperative time points. The study included 36 patients with medulla oblongata-involved tumours from January to December 2019, and found that 13.9% of them experienced postoperative NPE. The absence of intraoperative use of sevoflurane ( P =0.008), decreased concentrations of arginine ( P =0.026) and homoarginine ( P =0.030), and prolonged postoperative tracheal extubation ( P <0.001) were identified as independent risk factors for postoperative NPE in medulla oblongata-involved tumour patients. Pairwise comparison analysis revealed that the perioperative decreases in arginine and homoarginine concentrations mainly occurred within the postoperative 8 h. This study demonstrates that NPE is not uncommon in patients with medulla oblongata-involved tumours. The absence of intraoperative use of sevoflurane, decreased concentrations of plasmatic arginine and homoarginine, and prolonged postoperative tracheal extubation are independent predictors of postoperative NPE. These two neurotransmitters' concentrations dropped mainly within the early postoperative hours and could serve as potential early warning indicators of postoperative NPE in clinical practice.
Sections du résumé
BACKGROUND
BACKGROUND
This prospective clinical study aims to investigate the fluctuations of neurotransmitters in peripheral venous blood during the perioperative period and to identify independent predictors for postoperative neurogenic pulmonary oedema (NPE) in patients with medulla oblongata-involved tumours.
MATERIALS AND METHODS
METHODS
Peripheral venous blood samples of the enroled patients at seven perioperative time points, as well as their medical records and radiologic data were collected. High-performance liquid chromatography-tandem mass spectrometry was utilized to detect the concentrations of 39 neurotransmitters in these samples. The study applied univariate and multivariate generalized estimating equation (GEE) logistic regression analyses to explore independent predictors of postoperative NPE, and one-way repeated-measures ANOVA to compare the concentrations of the same neurotransmitter at different perioperative time points.
RESULTS
RESULTS
The study included 36 patients with medulla oblongata-involved tumours from January to December 2019, and found that 13.9% of them experienced postoperative NPE. The absence of intraoperative use of sevoflurane ( P =0.008), decreased concentrations of arginine ( P =0.026) and homoarginine ( P =0.030), and prolonged postoperative tracheal extubation ( P <0.001) were identified as independent risk factors for postoperative NPE in medulla oblongata-involved tumour patients. Pairwise comparison analysis revealed that the perioperative decreases in arginine and homoarginine concentrations mainly occurred within the postoperative 8 h.
CONCLUSION
CONCLUSIONS
This study demonstrates that NPE is not uncommon in patients with medulla oblongata-involved tumours. The absence of intraoperative use of sevoflurane, decreased concentrations of plasmatic arginine and homoarginine, and prolonged postoperative tracheal extubation are independent predictors of postoperative NPE. These two neurotransmitters' concentrations dropped mainly within the early postoperative hours and could serve as potential early warning indicators of postoperative NPE in clinical practice.
Identifiants
pubmed: 38079589
doi: 10.1097/JS9.0000000000000957
pii: 01279778-990000000-00881
pmc: PMC10942246
doi:
Substances chimiques
Homoarginine
156-86-5
Arginine
94ZLA3W45F
Sevoflurane
38LVP0K73A
Neurotransmitter Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1475-1483Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
Med Hypotheses. 2020 Apr;137:109538
pubmed: 31911369
Curr Opin Clin Nutr Metab Care. 2003 Mar;6(2):223-8
pubmed: 12589193
Int J Cardiol. 2016 Aug 15;217:12-5
pubmed: 27174592
Crit Care Med. 2001 Jun;29(6):1222-8
pubmed: 11395608
Surgery. 1995 Feb;117(2):213-9
pubmed: 7846628
Eur Neurol. 2019;81(1-2):94-102
pubmed: 31117074
Int J Cardiol. 2013 Oct 12;168(5):4907-9
pubmed: 23890923
Tohoku J Exp Med. 1987 Nov;153(3):197-205
pubmed: 3433275
Clinics (Sao Paulo). 2011;66(6):1061-6
pubmed: 21808876
J Hypertens. 2013 Jun;31(6):1114-23
pubmed: 23552121
FEBS Lett. 1995 Feb 13;359(2-3):251-4
pubmed: 7532597
Eur J Pharmacol. 2004 Sep 24;499(3):257-63
pubmed: 15381047
Annu Rev Pharmacol. 1975;15:105-30
pubmed: 238459
PLoS One. 2017 Oct 12;12(10):e0184973
pubmed: 29023577
Arq Neuropsiquiatr. 2001 Mar;59(1):40-5
pubmed: 11299429
Methods Mol Biol. 2016;1378:21-30
pubmed: 26602113
J Neurosurg Anesthesiol. 2017 Jan;29(1):37-45
pubmed: 27337676
Clin Chest Med. 1985 Sep;6(3):473-89
pubmed: 3907948
Heart. 2011 Aug;97(15):1222-7
pubmed: 21558479
JPEN J Parenter Enteral Nutr. 2012 Jan;36(1):53-9
pubmed: 22179519
PLoS One. 2018 Feb 22;13(2):e0192896
pubmed: 29470503
Curr Opin Clin Nutr Metab Care. 2007 Jan;10(1):80-7
pubmed: 17143060
Ann Surg. 2001 Mar;233(3):393-9
pubmed: 11224628
Case Rep Pulmonol. 2018 Aug 19;2018:3483282
pubmed: 30210892
Metabolism. 1997 Sep;46(9):1024-31
pubmed: 9284891
J Neurosurg. 2015 Feb;122(2):400-7
pubmed: 25423271
Int J Surg. 2021 Dec;96:106165
pubmed: 34774726
Am J Physiol. 1995 Jul;269(1 Pt 2):R160-6
pubmed: 7631888
Br J Pharmacol. 1997 Jun;121(3):395-400
pubmed: 9179379
Arterioscler Thromb Vasc Biol. 2014 Nov;34(11):2501-7
pubmed: 25189571
Brain Res Bull. 2020 Dec;165:281-289
pubmed: 33080307
Nat Rev Neurosci. 2007 Oct;8(10):766-75
pubmed: 17882254
FEBS Lett. 2012 Oct 19;586(20):3653-7
pubmed: 23010440
Br J Clin Pharmacol. 1998 Nov;46(5):489-97
pubmed: 9833603
Crit Care. 2012 Dec 12;16(2):212
pubmed: 22429697
Anal Chem. 1996 Oct 1;68(19):3520-3
pubmed: 8843144
BMC Surg. 2021 Feb 21;21(1):94
pubmed: 33612095
Drug Des Devel Ther. 2018 Mar 23;12:629-638
pubmed: 29606856