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British Journal of Anaesthesia, 1993, Vol. 71, No. 6 858-863
© 1993 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

POSTOPERATIVE MULTIPLE ORGAN DYSFUNCTION SYNDROME ASSOCIATED WITH GUT MUCOSAL HYPOPERFUSION, INCREASED NEUTROPHIL DEGRANULATION AND C1-ESTERASE INHIBITOR DEPLETION

M. G. MYTHEN, M.B., B.S., F.R.C.A., G. PURDY, N.Z.I.M.L.T., I. J. MACKIE, B.SC., PH.D., M.R.C.PATH., F.I.M.L.S., T. MCNALLY, B.SC., A. R. WEBB, M.B., B.CH., M.R.C.P. and S. J. MACHIN, M.B., CH.B., M.R.C.P., F.R.C.PATH.

The Bloomsbury Institute of Intensive Care Medicine, The Middlesex Hospital Mortimer Street, London W1N 8AA
Department of Haematology, UCL Medical School London W1C 6HX

We have examined the relationship between gut mucosal perfusion, as determined by gastric intramucosal pH (pHi), changes in plasma neutrophil elastase concentrations and components of the contact system during elective major surgery and related these findings to patient outcome. Of the 26 patients studied, 16 developed gut mucosal hypoperfusion (pHi<7.32) by the end of surgery; four of these developed multiple organ dysfunction syndrome; three of these died. In this group there was a significant increase in neutrophil elastase (P<0.005) and significant reductions in plasma components of the contact system from immedi ately before surgery to 24 h later. Ten patients maintained gut mucosal perfusion (pHi ≥ 7.32); none of these developed life threatening com plications. In this group there was no significant increase in neutrophil elastase and, although there were significant reductions in some plasma com ponents of the contact system, concentrations of C1-esterase inhibitor (the main inhibitor of the contact system) were not significantly reduced. We conclude that gut mucosal hypoperfusion, neutro phil degranulation and activation of the contact system to the extent that C1-esterase inhibitor becomes depleted are associated with a poor outcome after major surgery. (Br. J. Anaesth. 1993; 71; 858–863)


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