HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Panagiotis Misthos Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Misthos, P. Articles by Katsaragakis, S. Search for Related Content PubMed Articles by Misthos, P. Articles by Katsaragakis, S. Related Collections Anesthesia Lung - basic science

Eur J Cardiothorac Surg 2006;30:413
© 2006 Elsevier Science NL

Letter to the Editor

Reply to Birdas

^a First Thoracic Surgical Department, "SOTIRIA" General Hospital for Chest Diseases, Athens, Greece
^b University of Athens Medical School, First Propaedeutic Surgical Department, Athens, Greece

Received 27 April 2006; accepted 1 May 2006.

^_* Corresponding author. Address: 16-18 Markou Avgeri Street, 15343 Agia Paraskevi, Athens, Greece. Tel.: +30 2106080107; fax: +30 2106080107. (Email: panmisthos{at}yahoo.gr).

Key Words: Oxidative stress • Lung reexpansion • Postresectional complications

We appreciate the comments of Dr Birdas. One-lung ventilation (OLV) is widely used in thoracic surgery. In our initial report the generation of oxidative stress after OLV was demonstrated [1]. Due to complete lack of previous solid evidence the aim of our next study was to study whether there is any association between postresectional oxidative stress and postoperative complications [2]. This was a preliminary work.

Some degree of free radicals are generated in almost every physiologic and pathophysiologic pathway. However, their actual impact on clinical situations is still under investigation. Thus, any possible perioperative parameter, situation, complication or drug may affect the level of free radicals and consequently should be entered into multivariate analysis. This would lead to extreme complexity of the study plan with variables that have not thoroughly checked for their role, if any, on the generation of oxidative stress. In order to bypass this fundamental obstacle to our study methodology, we decided to use the most common variables that have already been proved to be independent risk factors for postoperative complication after lung resection surgery and compare them with oxidative stress per se: cases with hemoglobin <9 mg/l, albumin <2.5 mg/dl, diabetes mellitus, serum creatinine >1.5 mg/l, preoperative FEV1 <2 l, PaO₂ <70 mmHg, preoperative PaCO₂ >45 mmHg, history of coronary artery disease, concurrent thoracic wall excision, intraoperative blood loss >300 ml, duration from entrance into the pleura space until lobectomy completion >1 h and need for intensive care unit postoperatively were recorded. These factors along with other clinical characteristics such as age >65 years, gender, side of the lesion and pathologic staging were subjected to multivariate analysis with independent variables set by the results of the univariate analysis about the most common complications in OLV groups in order to evaluate the role of oxidative stress as an independent risk factor.

The authors want to state that it is our routine policy not to give prophylactic antiarrhythmic medication. Cardiac arrhythmias are usually detected on the second or third postoperative day. This might be explained by long-acting biochemical pathways that may be triggered by the short-lived (12 h) oxidative response. There are some indications on subcellular level for long-acting effects after experimental lung oxidative stress [3].

This is actually a work in progress. Our paper [2] was the first one that studied the relation between the systematic generation of free radicals and adverse effects after lung resection surgery. We fully agree to the recommendation for further studies to evaluate in more detail the role of intraoperative oxidative stress on postoperative complications. Dr Birdas’ remarks will help us with our future projects on this subject.

References

1. Misthos P, Katsaragakis S, Milingos N, Kakaris S, Sepsas E, Athanassiadi K, Theodorou D, Skottis I. Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation. Eur J Cardiothorac Surg 2005;27(3):379-383.[Abstract/Free Full Text]
2. Misthos P, Katsaragakis S, Theodorou D, Milingos N, Skottis I. The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study. Eur J Cardiothorac Surg 2006;29(4):591-595.[Abstract/Free Full Text]
3. Khoo JP, Zhao L, Alp NJ, Bendall JK, Nicoli T, Rockett K, Wilkins MR, Channon KM. Pivotal role for endothelial tetrahydrobiopterin in pulmonary hypertension. Circulation 2005;111(16):2126-2133.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Panagiotis Misthos Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Misthos, P. Articles by Katsaragakis, S. Search for Related Content PubMed Articles by Misthos, P. Articles by Katsaragakis, S. Related Collections Anesthesia Lung - basic science