Reduction of Perioperative Endotoxin Leakage from the Gastrointestinal Tract by Enteral Application of Immunoglobulin-enriched Colostral Milk Preparation

The pathogenetic role of endotoxin in gram-negative sepsis is generally accepted [1, 2]. In septic diseases the role of intestinal endotoxin reaching the bloodstream was experimentally demonstrated by Cuevas and Fine more than 20 years ago [3]. In recent studies endotoxemia has been observed during and after major surgical procedures such as vascular, abdominal and cardiac operations [4-9]. In the case of abdominal surgery there is clear evidence of a pathogenetic role of endotoxin in terms of an association of endotoxemia and the occurrence of infectious complications [4]. In patients who had had cardiac surgery the endotoxin plasma levels correlated with the catecholamines needed to obtain adequate hemodynamic conditions at the end of cardiopulmonary bypass [9]. Martinez et al. demonstrated in cardiacpatients that the severity of endotoxemia could be reduced by preoperative selective decontamination of the gastrointestinal tract, supporting the relevance of endotoxin translocation from the gastrointestinal tract [10].