Document Detail

Changes in gastric intramucosal pH following mesenteric traction in patients undergoing pancreas surgery.
MedLine Citation:
PMID:  10207237     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIM: During major abdominal surgery, mesenteric traction (MT) may result in hemodynamic instability mainly due to endogenous prostacyclin release. Gastric intramucosal pH (pHi) and PiCO2 are indicators of splanchnic tissue perfusion with a predictive value for the postoperative outcome. We investigated the influence of MT on gastric pHi and on postoperative outcome in patients undergoing pancreas surgery. METHODS: Forty-six consecutive patients scheduled for pancreas surgery were investigated. We registered hemodynamics and pHi by gastric tonometry and documented postoperative outcome (complications, hospital stay). Baseline data (T0) were recorded after skin incision. Further assessments followed 30, 60 and 120 min after intentional MT (T1-3) and at the end of surgery (T4). RESULTS: Thirty-three patients demonstrated a decrease in mean arterial pressure (MAP) following MT, whereas 13 patients showed entirely stable hemodynamics. The significant reduction in MAP in patients with an MT response was not associated with changes in pHi as compared to patients with no response (stable MAP) (T0 7.34 +/- 0.08 vs. 7.35 +/- 0.06; T1 7.34 +/- 0.05 vs. 7.32 +/- 0.07; T2 7.32 +/- 0. 05 vs. 7.31 +/- 0.08; T3 7.32 +/- 0.05 vs. 7.32 +/- 0.07; T4 7.26 +/- 0.1 vs. 7.27 +/- 0.08; mean +/- SD, MT response vs. no response). Neither MT response nor gastric intramucosal acidosis as evidenced by a pHi <7.32 at the end of surgery predicted postoperative complications or longer hospital stay. CONCLUSION: No deterioration of gastric pHi was found, which could reflect acceptable splanchnic perfusion and oxygenation despite systemic blood pressure reactions in patients experiencing an MT response.
A Brinkmann; W Seeling; M Rockemann; J H Junge; P Radermacher; H Wiedeck; M W Büchler; M Georgieff
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Digestive surgery     Volume:  16     ISSN:  0253-4886     ISO Abbreviation:  Dig Surg     Publication Date:  1999  
Date Detail:
Created Date:  1999-07-22     Completed Date:  1999-07-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8501808     Medline TA:  Dig Surg     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  117-24     Citation Subset:  IM    
Department of Anesthesiology, University Clinics, Ulm, Germany.
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MeSH Terms
Analysis of Variance
Follow-Up Studies
Gastric Mucosa / secretion*
Hemodynamics / physiology
Hydrogen-Ion Concentration*
Intraoperative Complications / diagnosis*
Mesentery / blood supply*,  surgery
Middle Aged
Monitoring, Intraoperative
Pancreatectomy / adverse effects*,  methods
Pancreatic Diseases / surgery*
Predictive Value of Tests
Treatment Outcome

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