In Vitro Study of Variables Relevant to Perioperative Care of the Surgical Patient: Glucose, Osmolarity, and Rewarming

• Published in: Journal of the American College of Surgeons Vol. 212; no. 2; pp. 180 - 186
• Main Authors: Dickinson, Ashley, BS, Qadan, Motaz, MD, PhD, Weller, Clayton, BA, Gardner, Sarah, BS, Polk, Hiram C., MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2011; Elsevier
• Subjects: Biological and medical sciences; Blood Glucose - metabolism; Flow Cytometry; General aspects; Glucose - administration & dosage; HLA-DR Antigens - biosynthesis; Humans; Hypothermia - blood; Hypothermia - etiology; Hypothermia - immunology; Hypothermia - therapy; In Vitro Techniques; Lipopolysaccharides; Mannitol - administration & dosage; Medical sciences; Osmolar Concentration; Perioperative Care - methods; Perioperative Care - standards; Reactive Oxygen Species - metabolism; Rewarming; Surgery; Surgical Procedures, Operative - adverse effects; Temperature; MCF; dihydrorhodamine; PMA; ethylenediaminetetraacetic acid; ROS; reactive oxygen species; EDTA; lipopolysaccharide; mean channel fluorescence; LPS; phorbol myristate acetate; DHR; Human; Medicine; Perioperative; Treatment; Variable; Osmolarity; Surgery; Patient; Glucose; In vitro; Care
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2010.09.023

Background We sought to determine the effects of altering osmolarity and the reversibility of the detrimental immunologic effects of hypothermia on human monocyte HLA-DR surface expression and reactive oxygen species (ROS) formation. Study Design The effects of altering osmolarity on HLA-DR surface expression and ROS formation were assessed using lipopolysaccharide (LPS)-treated samples treated with either saline, glucose, or mannitol, incubated at 37°C for 2 hours. HLA-DR surface receptor expression and ROS formation were determined after incubation. The effects of the reversibility of hypothermia were measured by incubating LPS-treated samples at 34°C, 37°C, and 40°C for 1 hour. The samples were subsequently rewarmed at 40°C for 1 and 2 hours. The effects of rewarming on HLA-DR surface receptor expression and ROS formation were reassessed. Results In the osmolarity experiments, there was a 49% decrease in ROS formation in samples treated with mannitol as compared with saline and glucose. Alterations of osmolarity had no significant effect on HLA-DR surface expression. In the rewarming experiments, rewarming for either 1 or 2 hours abolished any significant differences in HLA-DR surface expression and ROS formation between samples preincubated at the different temperatures. Conclusions The presumed inert mannitol was found to significantly decrease ROS formation, but had no effect on HLA-DR surface expression. In addition, the effects of hypothermia on HLA-DR surface expression or ROS formation may be better reversed within 2 hours than in 1 hour.