Influence of low dose allopurinol on ischaemia--reperfusion injury during abdominal aortic surgery.
OBJECTIVE
To ascertain whether surgery causes ischaemia-reperfusion (I-R) related injury, if this injury is augmented by preoperative shock, and reduced with low dose allopurinol.


METHODS
Randomised blind placebo controlled trial.


METHODS
Surgical laboratory.


METHODS
22 pigs were randomly allocated to four groups; OP = operation/placebo, OA = operation/ allopurinol, SOP = shock + operation/placebo, SOA = shock + operation/allopurinol. An aortic tube prosthesis was inserted in all. In groups SOP and SOA preoperative shock was induced by exsanguination. Allopurinol was administered in group OA on the preoperative day and peroperatively, in group SOA during shock and peroperatively.


METHODS
Perioperative blood concentrations of thiobarbituric acid reactive species (TBARS), ascorbic acid (AA), albumin, 99mTc-albumin and creatine phosphokinase (CPK) as indicators of oxidative membrane damage, antioxidant activity, microvascular permeability changes and muscular cell damage respectively.


RESULTS
In the OP and OA groups TBARS gradually increased, while AA, 99mTc-albumin and CPK remained unchanged and albumin decreased. No effect of allopurinol was observed in these groups. In the SOP group TBARS and AA were not significantly different from groups OP and OA. Yet, albumin, 99mTc-albumin and CPK decreased significantly more in the SOP group. Compared with the SOP group, allopurinol treatment (SOA) produced lower TBARS and higher AA levels, and reduced the effect of shock on albumin, 99mTc-albumin and CPK concentrations.


CONCLUSIONS
Aortic surgery causes no I-R related damage. Pre-operative shock produces I-R related damage, which is reduced by allopurinol.
Smeets
H J
HJ
Department of Surgery, University Hospital Leiden, The Netherlands.
Camps
J
J
van Milligen de Wit
A W
AW
Kievit
J
J
van Bockel
J H
JH
Hermans
J
J
Berger
H M
HM
D000493:Allopurinol / Q000008:administration & dosage / Q000627:therapeutic use*; D000818:Animals; D000975:Antioxidants / Q000378:metabolism; D001012:Aorta, Abdominal / Q000601:surgery*; D001205:Ascorbic Acid / Q000097:blood; D001807:Blood Vessel Prosthesis; D002199:Capillary Permeability; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006098:Granulocytes / Q000473:pathology; D007511:Ischemia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D018482:Muscle, Skeletal / Q000201:enzymology / Q000378:metabolism; D010084:Oxidation-Reduction; D010919:Placebos; D011897:Random Allocation; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D012709:Serum Albumin / Q000032:analysis; D012769:Shock / Q000097:blood / Q000150:complications; D016037:Single-Blind Method; D013552:Swine; D013667:Technetium; D017392:Thiobarbituric Acid Reactive Substances / Q000032:analysis
D000975:Antioxidants; D010919:Placebos; D012709:Serum Albumin; D017392:Thiobarbituric Acid Reactive Substances; D000493:Allopurinol; D013667:Technetium; D003402:Creatine Kinase; D001205:Ascorbic Acid