Document Detail


Aortic cross-clamping and reperfusion in pigs reduces microvascular oxygenation by altered systemic and regional blood flow distribution.
MedLine Citation:
PMID:  20584875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In this study, we tested the hypothesis that aortic cross-clamping (ACC) and reperfusion cause distributive alterations of oxygenation and perfusion in the microcirculation of the gut and kidneys despite normal systemic hemodynamics and oxygenation. METHODS: Fifteen anesthetized pigs were randomized between an ACC group (n = 10), undergoing 45 minutes of aortic clamping above the superior mesenteric artery, and a time-matched sham surgery control group (n = 5). Systemic, intestinal, and renal hemodynamics and oxygenation variables were monitored during 4 hours of reperfusion. Microvascular oxygen partial pressure (microPo(2)) was measured in the intestinal serosa and mucosa and the renal cortex, using the Pd-porphyrin phosphorescence technique. Intestinal luminal Pco(2) was determined by air tonometry and the serosal microvascular flow by orthogonal polarization spectral imaging. RESULTS: Organ blood flow and renal and intestinal microPo(2) decreased significantly during ACC, whereas the intestinal oxygen extraction and Pco(2) gap increased. The intestinal response to reperfusion after ACC was a sustained reactive hyperemia but no such effect was seen in the kidney. Despite a sustained high intestinal O(2) delivery, serosal microPo(2) (median [range], 49 mm Hg [41-67 mm Hg] versus 37 mm Hg [27-41 mm Hg]; P < 0.05 baseline versus 4 hours reperfusion) and the absolute number of perfused microvessels decreased along with an increased intestinal Pco(2) gap (17 mm Hg [10-19 mm Hg] versus 23 mm Hg [19-30 mm Hg]; P < 0.05). In contrast, the kidney showed a progressive O(2) delivery decrease accompanied by a decrease in renal cortex oxygenation (70 mm Hg [52-93 mm Hg] versus 57 mm Hg [33-64 mm Hg]; P < 0.05). CONCLUSION: Increased systemic and regional blood flow and oxygen supply after ACC does not ensure adequate regional blood flow and microcirculatory oxygenation in all organs.
Authors:
Martin Siegemund; Jasper van Bommel; Michiel E Stegenga; Wolfgang Studer; Mat van Iterson; Sandra Annaheim; Alexandre Mebazaa; Can Ince
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-28
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  345-53     Citation Subset:  AIM; IM    
Affiliation:
Department Anaesthesia and Critical Care Medicine, University Hospital, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland. siegemundm@uhbs.c
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MeSH Terms
Descriptor/Qualifier:
Animals
Aorta / surgery*
Carbon Dioxide / blood
Constriction
Disease Models, Animal
Hyperemia / blood,  physiopathology
Ileum / blood supply*
Kidney / blood supply*
Male
Microcirculation*
Oxygen / blood*
Partial Pressure
Regional Blood Flow
Renal Circulation*
Reperfusion*
Reperfusion Injury / blood,  etiology,  physiopathology*
Splanchnic Circulation*
Swine
Time Factors
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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