Document Detail

The effect of nitroglycerin on microvascular perfusion and oxygenation during gastric tube reconstruction.
MedLine Citation:
PMID:  15781529     Owner:  NLM     Status:  MEDLINE    
Esophagectomy followed by gastric tube reconstruction is the surgical treatment of choice for patients with esophageal cancer. Complications of the cervical anastomosis are associated with impaired microvascular blood flow (MBF) and ischemia in the gastric fundus. The aim of the present study was to differentiate whether the decrease in MBF is a result of arterial insufficiency or of venous congestion. To do this we assessed MBF, microvascular hemoglobin oxygen saturation (muHbSo(2)), and microvascular hemoglobin concentration (muHbcon) simultaneously during different stages of gastric tube reconstruction. In 14 patients, MBF was determined with laser Doppler flowmetry, and muHbSo(2) and muHbcon were determined with reflectance spectro- photometry. After completion of the anastomosis, nitroglycerin was applied at the fundus. Although MBF did not change significantly in the pylorus, MBF decreased progressively during surgery in the fundus from 210 +/- 18 Arbitrary Units at baseline (normal stomach) to 52 +/- 9 Arbitrary Units after completion of reconstruction (mean +/- sem; P < 0.05). There was no change in muHbSo(2) and muHbcon during the reconstruction. After application of nitroglycerin, MBF doubled. We conclude that MBF decreases during gastric tube reconstruction but that muHbSo(2) and muHbcon do not. This decrease might be the result of venous congestion, which can partly be counteracted by application of nitroglycerin.
Marc P Buise; Can Ince; Hugo W Tilanus; Jan Klein; Diederik Gommers; Jasper van Bommel
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  100     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-22     Completed Date:  2005-04-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1107-11     Citation Subset:  AIM; IM    
Department of Anesthesiology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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MeSH Terms
Arteries / surgery
Blood Gas Analysis
Esophageal Neoplasms / surgery
Esophagus / surgery*
Hemodynamics / drug effects
Hemoglobins / metabolism
Laser-Doppler Flowmetry
Microcirculation / drug effects
Middle Aged
Nitroglycerin / pharmacology*
Oxygen / blood*
Reconstructive Surgical Procedures*
Regional Blood Flow / drug effects
Stomach / blood supply*,  drug effects,  surgery
Vasodilator Agents / pharmacology*
Reg. No./Substance:
0/Hemoglobins; 0/Vasodilator Agents; 55-63-0/Nitroglycerin; 7782-44-7/Oxygen

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

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