Salivary monitoring related to major surgery.
BACKGROUND
Prolonged surgical procedures involving stress, extended general anaesthesia and a long pre-surgical fasting period may have systemic effects such as alterations in saliva flow rate and composition. These may compromise the patient's electrolytes and fluid balance and cause dehydration, systemic stress and oxidative changes.


METHODS
Saliva was collected prior and following surgery from 20 patients and 20 control subjects. The saliva samples were analysed for flow rates and levels of the following: calcium (Ca), magnesium (Mg), total protein, albumin and lactate dehydrogenase (LDH), total antioxidant status (TAS), uric acid (UA), superoxide dismutase (SOD), carbonyls, matrix metalloproteinases (MMPs) -2, -3 and -9 and heat shock proteins (HSPs) 70 and 90.


RESULTS
Salivary levels of Ca, Mg, protein, albumin and LDH were higher in post-surgical patients by 70% (P = 0·002), 88% (P = 0·0001), 120% (P = 0·13), 111% (P = 0·039) and 492% (P = 0·006) respectively than that in healthy controls. Salivary antioxidants in the surgical patients were higher while salivary carbonyls remained unchanged. Salivary TAS levels in pre- and post-surgical patients were higher by 63% (P = 0·001) and 85% (P = 0·0001) respectively, UA concentrations by 92% (P = 0·014) and 81% (P = 0·036) respectively and SOD values by 47% (P = 0·61) and 112% (P = 0·049) respectively. Salivary concentrations of MMP3 were higher in pre- and post-surgical patients by 23% (P = 0·067) and 30% (P = 0·044) respectively.


CONCLUSIONS
Local salivary, oral and systemic-induced alterations should be prevented. Moreover, salivary collection and analysis may be a new, efficient tool in the monitoring of patients undergoing major surgery. Further related research is necessary.
Ullmann
Yehuda
Y
Department of Plastic Surgery, Rambam Health Care Campus, Haifa, Israel.
Klein
Yuval
Y
Savulescu
Dana
D
Borovoi
Iris
I
Egozi
Dana
D
Gavish
Moshe
M
Nagler
Rafael
R
D000328:Adult; D000418:Albumins / Q000032:analysis; D000975:Antioxidants / Q000032:analysis; D002118:Calcium / Q000032:analysis; D017558:Elective Surgical Procedures; D005260:Female; D018840:HSP70 Heat-Shock Proteins / Q000032:analysis; D018841:HSP90 Heat-Shock Proteins / Q000032:analysis; D006801:Humans; D045022:Lactate Dehydrogenases / Q000032:analysis; D008274:Magnesium / Q000032:analysis; D008297:Male; D020782:Matrix Metalloproteinases / Q000032:analysis; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D012463:Saliva / Q000737:chemistry*; D012472:Salivation / Q000502:physiology*; D013482:Superoxide Dismutase / Q000032:analysis; D014527:Uric Acid / Q000032:analysis
D000418:Albumins; D000975:Antioxidants; D018840:HSP70 Heat-Shock Proteins; D018841:HSP90 Heat-Shock Proteins; D014527:Uric Acid; D045022:Lactate Dehydrogenases; D013482:Superoxide Dismutase; D020782:Matrix Metalloproteinases; D008274:Magnesium; D002118:Calcium