[Effect of prophylactic N-acetylcysteine on postoperative organ dysfunction and inflammatory markers after major abdominal surgery for cancer. Prospective, randomized, double-blind, placebo-controlled clinical trial].
OBJECTIVE
To investigate whether short-term N-acetylcysteine (NAC) infusion administered before and during extensive abdominal surgery could modify the progression of early postoperative organ dysfunction and systemic inflammatory response.


METHODS
After randomisation the treatment group (n = 47) received NAC (150 mg kg-1 bolus followed by a continuous infusion of 12 mg kg-1 h-1) and the placebo group (n = 46) received the same volume of 5% dextrose during surgery. Clinical progress was monitored by the Multiple organ dysfunction score, systemic inflammatory response by serum procalcitonin (PCT), C-reactive protein (CRP) and microalbuminuria during the first 3 postoperative days. Mann-Whitney and chi 2 tests were used for statistical analysis.


RESULTS
There was no significant difference between the two groups regarding the MODS, organ dysfunction, length of intensive care stay, days of mechanical ventilation and mortality. PCT and microalbuminuria did not differ significantly. Significantly lower CRP levels were found in the NAC group on day one and two [t24: median: 84.5 interquartile range: (62.48-120.25) vs. 118 (86-137) mg/l; p = 0.020; t48: 136 (103-232) vs. 195 (154.5-252) mg/l p = 0.013, NAC vs. placebo].


CONCLUSIONS
The results of this study do not support the routine use of NAC as a prophylactic drug during surgery, and reinforce previous evidence which challenge the indication of NAC in the critically ill patient.
Szakmány
Tamás
T
Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Anaesthesiológiai és Intenziv Terápiás Intézet, 7643 Pécs.
Tóth
Ildikó
I
Márton
Sándor
S
Molnár
Zsolt
Z
D000008:Abdominal Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000419:Albuminuria / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003422:Critical Care; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012121:Respiration, Artificial; D016896:Treatment Outcome
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide; D000111:Acetylcysteine