Nitrite/nitrate oxide and cytokines changes in patients with surgical stress.

Nitric oxide (NO) produced by inducible nitric oxide synthase (iNOS) is implicated in immunological and inflammatory processes. Inflammatory cytokines and endotoxin induce a large amount of NO from various cells. Surgical stress produces cytokines, which leads to systemic inflammatory response syndrome (SIRS). Continuously high production of cytokines causes a variety of complications including pneumonia, intraabdominal abscess and sepsis. We investigated the relationships between the nitrite/nitrate (NOx) concentration and the level of cytokines in 50 patients undergoing gastroenterological surgery. We measured the levels of cytokines, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) interleukin-1 receptor antagonist (IL- 1ra), and nitrite/nitrate (NOx) concentration in the serum and exudative fluid from the thoracic or abdominal cavity of 50 patients undergoing gastroenterological surgery in order to make clear the relationship between cytokines and NO. NOx levels in the serum of the group with complications were higher on days 3 and 7 than in the group with no complications (P < 0.05). In the complications group, IL-6 was more elevated, and the NOx level was synchronously elevated. In conclusion, surgical stress caused inflammatory cytokinemia. NOx was produced during surgical stress, and when complications occurred, more NOx was produced.