SYSTEMIC ENDOTOXEMIA AND FIBRINOLYSIS DURING AORTIC-SURGERY

Objective: To determine whether endotoxaemia and activation of the sys temic fibrinolytic system occurs during and after aortic surgery. Desi gn: Prospective clinical study. Setting: University Hospital. Material s: 31 patients undergoing aortic surgery. Chief Outcome Measures: Veno us blood assay far endotoxin and plasminogen activator inhibitor-1 (PA I-I). Samples were obtained preoperatively, immediately before and 5 m inutes after cross-clamp application and removal, and at 2, 4, 6 and 2 4 hours postoperatively. Tonometric sigmoid intramural pH was monitore d throughout this period as a means of detecting colonic mucosal ischa emia. Main Results: Endotoxin levels increased after clamping of the a orta, peaking immediately before clamp removal, mean value 34.5 pg/ml, p <0.01, but returning to preoperative levels by 24 hours. PAI-1 leve ls progressively increased after surgery, with persistently high level s remaining at 24 hours (p <0.01). Conclusions: Endotoxaemia does occu r during aortic surgery and appears to be associated with activation o f the systemic fibrinolytic system.