Systemic inflammatory response, bacterial translocation and nitric oxide donors

Abdominal aortic surgery is relatively common and is associated with considerable post-operative morbidity and death. The aortic cross-clamping (supra or infrarenal) necessary for the insertion of a vascular graft, often in circumstances of haemorrhagic shock (e.e. a ruptured aneurysm) elicits a Systemic Inflammatory Response Syndrome (SIRS) and an Ischaemia-Reperfusion syndrome (I-R), with affectation of many organs including the kidneys and the intestine. Experimentally, the exogenous use of nitric oxide donors has proved to be able to control the SIRS, minimising the damage due to I-R and protecting from renal dysfunction and BT. However, clinical experience in these situations is still limited. Here we review the current status and experience of the authors in the use of nitric oxide donors in the control of the SIRS induced by infrarenal, suprarenal aortic cross-clamping, with or without haemorrhagic shock; and the Bacterial Translocation phenomenon (BT) induced by aortic cross-clamping below the mesenteric artery with or without associated hemorrhaging.