Controlling oxidative stress as a potential tool for perioperative management to reduce morbidity after surgical trauma

Abstract

Oxidative stress is considered to increase in proportion to the severity of surgical trauma. However, the biochemical marker which best reflects the severe oxidative stress following major surgery, such as esophagectomy, has not been determined. Multiple studies have concluded that there is a reduction in antioxidative activities in response to surgical trauma. Evidence from animal studies has shown that oxidative stress is associated with postoperative complications. Clinical studies have suggested that the oxidative stress after ischemia-reperfusion injury, caused by surgery for abdominal aortic aneurysm and coronary artery bypass graft operation, is associated with subsequent surgical morbidities. A recent international, randomized, blinded trial involving critically ill patients with multiorgan failure revealed that supplementation with antioxidants, including selenium, zinc, beta-carotene, vitamin E, and vitamin C, showed no therapeutic benefits. In contrast, supplemental L-carnitine, glutamine, and coenzyme Q10 showed promising activity with the potential to reduce oxidative stress induced by surgical trauma or catheter angioplasty. Although there are still many unresolved issues, such as the optimum dose or the most appropriate antioxidant combination to treat a particular condition, controlling oxidative stress may be another potential tool for perioperative management to reduce morbidity after severe surgical trauma.