Document Detail


Flap flow and cardiac output as functions of pulmonary artery wedge pressure: experimental study in the pig.
MedLine Citation:
PMID:  9714037     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cardiac output (CO) is redistributed during hypovolemia, but it has not been clearly documented how this influences flap perfusion. Simultaneous changes in perfusion of a muscle flap and CO as modulated by reductions in cardiac filling pressure were compared in a pig model. The hypothesis was that flap flow (FF) would remain relatively constant as CO was reduced, according to the Frank-Starling curve. Under general anesthesia, five domestic pigs were utilized. Following right carotid artery cannulation, measurement of systemic blood pressure and blood gas analysis were carried out. An oximetric Swan-Ganz catheter insertion via the right internal jugular vein was used to measure CO, temperature, and pulmonary artery wedge pressure (PAWP). In the lateral decubitus position, a right latissimus dorsi muscle flap was elevated in the animal, using standard technique. The insertion of the muscle was divided, and a 1-cm section of thoracodorsal artery was mobilized to measure flap perfusion with a transonic Doppler flowmeter. After baseline measurements of PAWP, CO, and FF were obtained, blood volume was reduced in 350-cc aliquots at 10-min intervals. After each aliquot was removed, the hemodynamic parameters were again recorded. This procedure was repeated until the CO was less than 1.0 liter/min; at this point the pig was sacrificed. The mean baseline PAWP was 15.6+/-4.0 mmHg, which was reduced to 2.2+/-1.1 mmHg (p<0.05) by the end of the experiment. The mean baseline FF was 5.6+/-1.9 cc/sec, and the mean baseline CO was 4.6+/-1.0 l/min; these were reduced to 0.4+/-0.4 cc/sec (p< 0.05) and 1.1+/-0.1 l/min (p<0.05), respectively, by the end of the experiment. FF and CO were plotted as a function of PAWP and the two regression curves were evaluated by analysis of covariance. The slope of these curves was not different, p=0.4. The hypothesis that FF would be preserved in the face of reductions in CO did not prove to be correct in this experiment. Changes in FF paralleled changes in CO as the PAWP was reduced. Inhalation anesthesia and local sympathectomy may influence flap perfusion during hypovolemia. These results underscore the importance of avoiding hypovolemia during flap surgery, in order to maintain flap perfusion.
Authors:
R Lohman; A Gürlek; M A Schusterman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of reconstructive microsurgery     Volume:  14     ISSN:  0743-684X     ISO Abbreviation:  J Reconstr Microsurg     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-10-20     Completed Date:  1998-10-20     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  8502670     Medline TA:  J Reconstr Microsurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  317-21     Citation Subset:  IM    
Affiliation:
Department of Plastic Surgery, M.D. Anderson Cancer Center, University of Texas, Houston, USA.
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MeSH Terms
Descriptor/Qualifier:
Anesthetics, Inhalation / pharmacology
Animals
Blood Pressure / physiology
Blood Volume / physiology
Body Temperature
Carbon Dioxide / blood
Cardiac Output / physiology*
Cardiac Volume / physiology
Catheterization, Central Venous
Catheterization, Swan-Ganz
Disease Models, Animal
Jugular Veins
Muscle, Skeletal / blood supply,  transplantation*,  ultrasonography
Oximetry
Oxygen / blood
Pulmonary Wedge Pressure / physiology*
Regional Blood Flow / physiology
Regression Analysis
Surgical Flaps / blood supply*
Swine
Sympathectomy
Ultrasonography, Doppler
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 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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