THE NONSPECIFIC INFLAMMATORY RESPONSE TO INJURY

Citation
I. Mayers et D. Johnson, THE NONSPECIFIC INFLAMMATORY RESPONSE TO INJURY, Canadian journal of anaesthesia, 45(9), 1998, pp. 871-879
Citations number
93
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0832-610X
Volume
45
Issue
9
Year of publication
1998
Pages
871 - 879
Database
ISI
SICI code
0832-610X(1998)45:9<871:TNIRTI>2.0.ZU;2-R
Abstract
Purpose: The role of the nonspecific inflammatory response in causing injury related to surgery has become bet ter understood over the last decade. There are complex interactions between neutrophils, cytokines- and nitric oxide metabolites that may cause organ injury following sur gery. The purpose of this review is to summarize some of the processes causing injury through these nonspecific pathways. Methods: A review of the medical and anaesthetic literature related to inflammation, neu trophils and pro-inflammatory cytokines were performed using Medline, Bibliographies of relevant articles were searched and additional artic les were then selected and reviewed. Results: Pro-inflammatory cytokin es, such as tumour necrosis factor, are released in response to a vari ety of noxious stimuli (e.g. burns, sepsis, or CABG surgery). These cy tokines cause activation of neutrophils with increased up-regulation o f adhesion complexes on neutrophils and vascular endothelium. Nitric o xide synthase activity is also increased with a resultant increased pr oduction of nitric oxide. The Increased nitric oxide concentration in the presence of superoxide free radicals secreted by activated neutrop hils forms peroxynitrite, a more reactive and toxic molecule. Once thi s process is initiated, diffuse organ injury can result, Although some information related to specific anaesthetics is available, firm recom mendations related to clinical practice cannot be made. Conclusions: T here is a complex interplay of inflammatory mediators that can cause i njury. Although specific clinical applications for manipulating these pathways are not yet generally available, this area holds promise to d evelop new techniques to improve outcomes following surgery.