Mizushima M, Ueda M, Murakami F, Hanaoka Y, Yamamura T, Kemmotsu O
Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Masui. 1990 Aug;39(8):1028-32.
During a major abdominal surgery, intraoperative manipulation may cause circulatory changes, which lead to release of granulocyte elastase. Twenty one patients were studied to elucidate the release of granulocyte elastase and the inhibitory effect of a protease inhibitor (ulinastatin) on lysosomal enzyme release during pancreas surgery. Patients were divided into 3 groups. Patients in group A served as control. Patients in group B were given ulinastatin 10,000 units.kg-1 intravenously prior to surgery. Patients in group C were given ulinastatin 5,000 units.kg-1 intravenously twice prior to surgery and 3 hours after the start of surgery. The granulocyte elastase was measured by commercially available kits, at 7 points: prior to induction of anesthesia, immediately after tracheal intubation, 30, 60, 120, 180 min after the start of surgery and 30 min after surgery. The plasma level of elastase increased markedly during the operation in group A, it did not increase in groups B and C during the operation. Thirty min after the operation, the plasma level of elastase increased markedly in group A (354 +/- 63 micrograms.l-1), and in group B (396 +/- 167 micrograms.l-1). The plasma level of elastase was restored to normal levels 30 min after the operation in group C. These results indicate that granulocyte elastase values were maintained at significantly higher levels during and after pancreas surgery, and suggest that ulinastatin inhibits the release of granulocyte elastase during pancreas surgery.
