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BJA Advance Access published online on October 29, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei014
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted September 27, 2004

Clinical Investigation

Gut permeability in paediatric cardiac surgery

I. Malagon 1*, W. Onkenhout 2, G. Klok 2, P. F. H. van der Poel 2, J. G. Bovill 1, and M. G. Hazekamp 3

1 Department of Anaesthesia, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
2 Department of Paediatrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
3 Department of Paediatric Cardiac Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands

* To whom correspondence should be addressed.
I. Malagon, E-mail: jmalagon{at}lumc.nl


  Abstract

Background. Intestinal mucosal ischaemia can occur in infants and children during and after cardiac surgery. Severe decreases in mucosal perfusion may cause complications such as necrotizing enterocolitis and postoperative mortality. We investigated gut permeability in paediatric patients undergoing cardiac surgery using the dual sugar permeability test and absorption of two other saccharides.

Methods. Thirty-four patients undergoing palliative or corrective surgical procedures with and without cardiopulmonary bypass were investigated. Intestinal permeability was measured using 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose, given orally after induction of anaesthesia and 12 and 24 h later.

Results. Lactulose/rhamnose ratios were raised from the outset [median 0.39 (confidence interval 0.07-1.8 for patients undergoing operations without cardiopulmonary bypass and 0.30 (0.02-2.6) with cardiopulmonary bypass]. The highest lactulose/rhamnose ratios were recorded 12 h after surgery 0.32 (0.07-6.9), when cardiopulmonary bypass was used. This is approximately seven times the value expected in healthy children. There was an improvement in patients not undergoing cardiopulmonary bypass: 0.22 (0.03-0.85) 12 h and 0.11 (0-0.48) 24 h after induction of anaesthesia. Patients undergoing repair of aortic coarctation showed the fastest recovery: 0.09 (0.03-0.31) 12 h and 0.07 (0.04-0.35) 24 h after induction of anaesthesia.

Conclusions. Patients with congenital heart defects have abnormal gut permeability when compared with healthy children of similar age. Cardiopulmonary bypass seems to affect the intestinal barrier morphologically (lactulose and rhamnose absorption) and functionally (3-O-methyl-D-glucose and D-xylose absorption).

Keywords: gastrointestinal tract, gut permeability; surgery, cardiovascular; surgery, paediatric.
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