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Gut permeability in paediatric cardiac surgery.
I Malagon1, W Onkenhout, G Klok
1Department of Anaesthesia, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands. jmalagon@lumc.nl
British Journal of Anaesthesia
|November 2, 2004
Summary
Pediatric cardiac surgery patients exhibit increased intestinal permeability, especially those on cardiopulmonary bypass. Gut barrier function improves over time, with faster recovery in aortic coarctation repair patients.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Cardiology
Background:
- Intestinal mucosal ischemia is a risk in pediatric cardiac surgery, potentially causing necrotizing enterocolitis and mortality.
- Assessing gut permeability is crucial for understanding post-surgical complications in children.
Purpose of the Study:
- To investigate gut permeability in pediatric patients undergoing cardiac surgery.
- To evaluate the impact of cardiopulmonary bypass on intestinal barrier function.
Main Methods:
- Dual sugar permeability test using 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose.
- Oral administration of saccharides at anesthesia induction, 12, and 24 hours post-surgery.
- Study included 34 pediatric patients with and without cardiopulmonary bypass.
Main Results:
- Elevated lactulose/rhamnose ratios indicated increased gut permeability in all cardiac surgery patients compared to healthy children.
- Cardiopulmonary bypass use was associated with the highest lactulose/rhamnose ratios 12 hours post-surgery.
- Patients not on cardiopulmonary bypass showed improved permeability over 24 hours; aortic coarctation repair patients recovered fastest.
Conclusions:
- Congenital heart defect patients undergoing cardiac surgery have impaired gut permeability.
- Cardiopulmonary bypass significantly affects the intestinal barrier's morphology and function.
- Intestinal permeability shows a trend towards normalization post-surgery, with varying recovery rates.