Effects of ulinastatin on pulmonary artery pressure during abdominal aortic aneurysmectomy.
OBJECTIVE
Abdominal aortic aneurysmectomy (AAAectomy) results in a general ischemia-reperfusion syndrome accompanied by an acute rise in pulmonary artery pressure (PAP). We examined whether ulinastatin, a urinary trypsin inhibitor, prevents ischemia-reperfusion injury and increase in PAP after aortic unclamping (XU) during AAAectomy.


METHODS
Prospective study.


METHODS
Public, university-affiliated hospital.


METHODS
Sixteen patients (11 males and 5 females) scheduled for AAAectomy.


METHODS
The patients received 300000 IU of ulinastatin intravenously before XU (n = 8) or no additional treatment (n = 8) (control). Heart rate, central venous pressure, PAP, pulmonary arterial wedge pressure, arterial pressure, mixed venous oxygen saturation (Sv(O2)), and cardiac output were monitored. Arterial and mixed venous blood samples were analyzed for pH, Pa(CO2), Pa(O2), hemoglobin, and oxygen saturation, and the physiological shunt function (Qs/Qt) were calculated. Plasma concentrations of malondialdehyde, myeloperoxidase, granulocyte elastase, alpha1-antitrypsine, and thromboxane B2 and the stable hydrolysis products of thromboxane A2 were measured. Measurements were conducted before aortic crossclamping (XC) (baseline) and at 10, 30, and 60 minutes after XU.


RESULTS
A significant increase in PAP was observed 10 minutes after XU in the control group but not in the ulinastatin group. At 60 minutes after XU, Qs/Qt values had increased in the control group but had decreased in the ulinastatin group. There were no significant changes in malondialdehyde, thromboxane B2, granulocyte elastase, and alpha1-antitrypsine levels after XU in either group. A significant decrease in the plasma level of myeloperoxidase after XU was found in both groups.


CONCLUSIONS
The present study demonstrated that ulinastatin prevents increase in PAP and shunting after XU during AAAectomy.
Kurosawa
Saori
S
Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan.
Kanaya
Noriaki
N
Fujimura
Naoyuki
N
Nakayama
Masayasu
M
Edanaga
Mitsutaka
M
Mizuno
Eri
E
Park
Kyung W
KW
Namiki
Akiyoshi
A
D000368:Aged; D001011:Aorta; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects*; D003250:Constriction; D005260:Female; D006023:Glycoproteins / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D009195:Peroxidase / Q000097:blood; D011651:Pulmonary Artery / Q000503:physiopathology*; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D013929:Thromboxane B2 / Q000097:blood; D014361:Trypsin Inhibitors / Q000008:administration & dosage*; D000515:alpha 1-Antitrypsin / Q000032:analysis
D006023:Glycoproteins; D014361:Trypsin Inhibitors; D000515:alpha 1-Antitrypsin; D008315:Malondialdehyde; D013929:Thromboxane B2; D009195:Peroxidase; D019272:Leukocyte Elastase; C028665:urinastatin