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Pulmonary edema after aneurysm surgery is modified by mannitol
I S Paterson1, J M Klausner, G Goldman
1Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Annals of Surgery
|December 1, 1989
Summary
Mannitol administration mitigates pulmonary complications following abdominal aortic aneurysmectomy (AAA) by inhibiting thromboxane synthesis. This treatment reduces pulmonary hypertension and edema, preserving lung function after surgery.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Medicine
- Pharmacology
Background:
- Abdominal aortic aneurysmectomy (AAA) is associated with significant pulmonary complications, including thromboxane A2 (TxA2) generation, pulmonary hypertension, leukopenia, and noncardiogenic pulmonary edema.
- These events contribute to increased perioperative morbidity and mortality.
- Hydroxyl radical scavengers are being investigated for their potential to mitigate these adverse effects.
Purpose of the Study:
- To investigate the efficacy of mannitol, a hydroxyl radical scavenger, in preventing pulmonary complications after AAA.
- To determine if mannitol modifies thromboxane generation, pulmonary artery pressure, white blood cell count, and pulmonary edema following AAA surgery.
Main Methods:
- A randomized controlled trial comparing intravenous mannitol (0.2 g/kg, n=14) versus saline (n=12) administered before infrarenal aortic clamping.
- Measurements included plasma thromboxane B2 (TxB2) levels, mean pulmonary artery pressure (MPAP), white blood cell (WBC) count, physiological shunting (Q[sc]S[xsc]/Q[sc]T[xsc]), and peak inspiratory pressure (PIP).
- In vitro studies assessed mannitol's effect on thromboxane synthesis by ADP-activated platelets.
Main Results:
- Saline group showed significant increases in TxB2, MPAP, shunting, and PIP, along with a decrease in WBC and development of pulmonary edema.
- Mannitol treatment significantly reduced TxB2 levels, MPAP, shunting, and PIP compared to saline (p < 0.01).
- Mannitol minimized the decline in WBC and prevented the occurrence of pulmonary edema post-AAA surgery.
Conclusions:
- Mannitol effectively preserves pulmonary function after abdominal aortic aneurysmectomy.
- The protective effect of mannitol appears to be mediated by the inhibition of ischemia-induced thromboxane synthesis.
- Mannitol represents a promising therapeutic agent for reducing perioperative pulmonary complications in AAA patients.