A Prophylactic Approach towards Postoperative Endotoxemia

Abstract

Many of the observed postoperative problems following extensive surgery may have the clinical features of a sepsis syndrome. For example hypotension, respiratory dysfunction, renal failure and liver failure can be seen in postoperative patients. A considerable number of these patients actually develops a full-blown sepsis syndrome. This is not surprising, because in addition to the increased risk for septic complications in an average hospitalized patient, a surgical patient also has been subjected to a loss of tissue integrity from a surgical procedure. Therefore, such a patient depends even more on his own immunocompetence. Recently, Shaw and Keao [1] stated that 50% of sepsis in the surgical unit occurred in postoperative patients. Intraabdominal abscesses, pulmonary infections and wound infection often underlied the development of sepsis. However, in a high percentage of patients no bacteria can be cultured, neither from the blood nor from other sites of the body. Circulating endotoxins have been frequently implicated as the cause of postoperative complications, even though studies on the presence of endotoxins in the blood revealed conflicting results [2–4]. The current review will briefly present evidence of the pathogenic role of postoperative endotoxemia in the clinical course of surgical patients. Recent data will be discussed that may provide a basis for future pre-operative selection and treatment of patients who are at risk for postoperative endotoxemia.