We have studied the effect of the carotid sinus baroreceptor reflex on respiration in 10 vagotomized, spontaneously breathing, pentobarbital anesthetized dogs. The carotid body chemoreceptor reflex response was eliminated by surgically excluding the carotid bodies from the carotid sinus baroreceptor area. Steady state frequency, tidal volume, and minute ventilation were measured after 25 mm Hg step changes in intrasinus pressure between 50 and 200 mm Hg. Over this range, the step decreases in intrasinus pressure caused concomitant increases in mean arterial pressure from 86 to 182 mm Hg. All of the respiratory response curves were sigmoidal in shape. Decreasing intrasinus pressure from 200 to 50 mm Hg caused respiratory frequency to increase from 4.8 to 9.7/min, and tidal volume to decrease from 704 to 515 ml. The calculated total ventilation, however, increased from 3180 to 4530 ml/min. The time of inspiration decreased from 3.7 to 2.4 seconds, and the time of expiration decreased from 9.8 to 4.1 seconds. These ventilatory responses are shown to be baroreceptor reflex mediated, and not secondary to changes in arterial pressure. These findings indicate that not only does the carotid sinus baroreceptor reflex control arterial pressure, but it also simultaneously influences ventilation, through changes in both respiratory frequency and tidal volume.

Minimally invasive liver surgery can be performed safely for minor hepatic resections and should be considered whenever possible. Minor liver resections can be performed by standard laparoscopy equivalent to robotic procedures. Nevertheless, the robot adds a technical upgrade which may have benefits for challenging cases and major liver surgery.

properties of the total systemic vascular bed of the dog.Epinephrine and the carotid sinus baroreceptor reflex. Influence on capacitive and resistive

BackgroundMinimally invasive liver surgery is growing worldwide with obvious benefits for the treated patients. These procedures maybe improved by robotic techniques, which add several innovative features. In Germany, we were the first surgical department implementing robotic assisted minimally invasive liver resections.Material and methodsBetween June 2013 and March 2015, we performed robotic based minimally invasive liver resections in nine patients with malignant liver disease. Five off these patients suffered from primary and four from secondary liver malignancies. We retrospectively analyzed the perioperative variables of these patients and the oncological follow up.ResultsMean age of the patients was 63 years (range 45–71). One patient suffered from intrahepatic cholangiocellular, four from hepatocellular carcinoma, and four patients from colorectal liver metastases. In six patients, left lateral liver resection, in two cases single segment resection, and in one case minimally invasive guided liver ablation were performed. Five patients underwent previous abdominal surgery. Mean operation time was 312 min (range 115–458 min). Mean weight of the liver specimens was 182 g (range 62–260 g) and mean estimated blood loss was 251 ml (range 10–650 ml). The mean tumor size was 4.4 cm (range 3.5–5.5 cm). In all cases, R0 status was confirmed with a mean margin of 0.6 cm (range 0.1–1.5 cm). One patient developed small bowel fistula on postoperative day 5, which could be treated conservatively. No patient died. Mean hospital stay of the patients was 6 days (range 3–10 days). During a mean follow up of 12 months (range 1–21 months), two patients developed tumor recurrence.ConclusionRobotic-based liver surgery is feasible in patients with primary and secondary liver malignancies. To achieve perioperative parameters comparable to open settings, the learning curve must be passed. Minor liver resections are good candidates to start this technique. But the huge benefits of robotic-based liver resections should be expected in extended procedures beyond minor liver resections with the currently available technology.

To understand more fully the role of the arterial baroreceptor reflex on systemic and pulmonary vascular resistance, we studied the influence of the carotid sinus baroreceptor reflex control system on the entire systemic and pulmonary arterial pressure-flow relationships. Ten pentobarbital-anesthetized dogs, whose carotid sinuses were isolated, were used in a preparation in which the right and left hearts were bypassed to control systemic and pulmonary blood flows. At intrasinus pressures of 50, 125, and 200 mm Hg, systemic and pulmonary arterial pressures were measured in response to step changes in systemic and pulmonary blood flows from 0 up to 200 ml/min per kg. The systemic arterial pressure-flow relationship exhibited a marked nonlinearity, especially at either high or low flows. A third-order polynomial fit was found to represent the steady state systemic arterial pressure-flow relationship best. Blood flow autoregulation was reflected as a secondary change in systemic arterial pressure at constant flow approximately 15 seconds after the initial response. Blood flow autoregulation was seen in the entire systemic vascular bed over the entire range of flows studied. The degree of autoregulatory significantly contributed to the shape of the systemic arterial pressure-flow relationship. The steady state arterial pressure-flow relationship shifted upward and toward the pressure axis, increasing the calculated incremental resistance and total peripheral resistance as intrasinus pressure was decreased. The systemic zero-flow arterial pressure was found to increase with decreases in intrasinus pressure. The pulmonary arterial pressure-flow relationship was found to be linear in the range of flows studied from 25 up to 200 ml/min per kg.(ABSTRACT TRUNCATED AT 250 WORDS)