Effect of protective solutions and hydroxyethyl starch in the attenuation of the injuries of ischemia and reperfusion of splanchnic organs

Abstract

PURPOSE: Vogt´s antioxidant solution (red blood cells, Ringer's solution, sodium bicarbonate, mannitol, allopurinol and 50% glucose) or its modification including hydroxyethyl starch (HES) were tested for the prevention of splanchnic artery occlusion shock. METHODS:Seventy rats were distributed in treatment (3), control (1), and sham (3) groups. Ischemia and reperfusion were induced by celiac, superior mesenteric and inferior mesenteric arteries occlusion for 40 min, followed by 60 min reperfusion or sham procedures.Controls received saline, both treatment and sham groups received the Vogt's solution, modified Vogt's solution (replacing Ringer's solution by HES), or HES. Mean arterial blood pressure (MABP), ileal malondialdehyde (MDA) and plasmatic MDA were determined, and a histologic grading system was used. RESULTS:At reperfusion, MABP dropped in all I/R groups. Only HES treatment was able to restore final MABP to the levels of sham groups. Plasmatic MDA did not show differences between groups. Ileum MDA was significantly higher in the control and treatment groups as compared to the sham group. Histology ranking was higher in the only in control group. CONCLUSIONS:Hydroxyethyl starch was able to prevent hemodynamic shock but not intestinal lesions. Both treatments with Vogt's solutions did not show any improvement.

Effects of different periods of gastric ischemia on liver as a remote organ

“…Gastric ischemia, such as the gut ischemia, unleashes a distributive shock due to the increase in the vascular permeability and reduction in aorta blood flow 9 and a local inflammatory process which extends to other organs and can be prolonged, giving rise to the onset of MODS 10 . Liver failure is a common complication in critical diseases and contributes to the worsening of patient prognosis [10][11][12][13][14][15] . The liver plays an important role in the immune, endocrine, and metabolic control, and is frequently damaged in medical conditions of shock, sepsis and systemic inflammation.…”

“…The reduction in the albumin values in the animals from the three groups reinforces the SIRS hypothesis, in which an increase in protein consumption occurs 5,11 . During SIRS, the albumin values can diminish in up to 70%, due to the vasodilation and hepatic prioritization for the syte-phase proteins 8,12 . No increase was observed in the values of other hepatic markers, probably due to the short period of observation of the animals.…”

“…For this reason, this study favored to evaluate the animals over a shorter period of time, in an attempt to verify the initial changes taking place in the liver. The first signs of liver failure result from the hypoperfusion of splanchnic organs 12 , which leads to an increase in the circulating values of hepatic markers, such as aminotransferases and bilirubins 11 . By contrast, secondary hepatic dysfunction, which is more severe than primary one, is characterized by structural and functional lesions, and results from the direct action of bacteria, endotoxins and inflammatory molecules, which unleash or perpetuate the systemic inflammation and organic dysfunction 11 .…”

“…By contrast, secondary hepatic dysfunction, which is more severe than primary one, is characterized by structural and functional lesions, and results from the direct action of bacteria, endotoxins and inflammatory molecules, which unleash or perpetuate the systemic inflammation and organic dysfunction 11 . Gastric ischemia causes a distributive shock, with a reduction in the splanchnic perfusion, which compromises the proper functions of the organ 12,16 . Diverse mechanisms are involved in the pathogenesis of this disorder, including the deformation of red blood cells, as well as an increase in both vascular permeability and the apoptosis of endothelial cells.…”