Nitric Oxide and the surgical patient: Identifying therapeutic targets

It has been a decade since the elucidation of the key components of L- argnine to the nitric oxide (NO) pathway. Knowledge in this field has expanded at a dizzying pace such that it is clear that NO participates in some way in essentially every physiologic process. Just as important has been the characterization of roles of NO in the pathophysiological features of many disease processes. New findings appear in the scientific literature at a rate that over-whelms even the most dedicated NO researchers. The universal interest in the biomedical importance of this molecule recently became evident with the creation of the Nitric Oxide Society along with its peer- reviewed publication. Nitric Oxide: Biology and Chemistry. With this tremendous investment of research resources, the clinician cannot help but wonder, 'What have we learned that is clinically relevant?' and 'Where are the therapeutic dividends?' This article will provide some of the key observations made about NO relevant to the biological responses of surgical patients and discuss some of the therapies based on NO research on the horizon. First, we will summarize basic NO biochemistry.