Dopexamine attenuates microvascular perfusion injury of the small bowel in pigs induced by extracorporeal circulation

Sack, FU; Reidenbach, Bettina; Schledt, Alexander; Dollner, Ralph; Taylor, Sarah; Gebhard, M. M.; Hagl, S.

doi:10.1093/bja/88.6.841

Cited by 17 publications

(7 citation statements)

References 25 publications

(8 reference statements)

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“…However, this would result in a baroreflex-mediated increase in HR, which again we did not observe. Nevertheless, blood flow may still be redistributed within the different organ systems, equating to no overall change, which is supported by studies in rats (Yeh et al 2012), but conflicted by several studies in pigs (Schwarz et al 2001;Sack et al 2002;Hiltebrand et al 2011). This finding might have been confounded by the slight variation in isoflurane percentages needed to maintain surgical levels of anesthesia across groups; although the lack of response differentiation between nondiabetic and diabetic animals suggests this is unlikely.…”

Section: Discussionmentioning

confidence: 99%

Effect of type 2 diabetes, surgical incision, and volatile anesthesia on hemodynamics in the rat

Bussey

Lamberts

2017

Physiol Rep

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Diabetic patients have increased cardiac complications during surgery, possibly due to impaired autonomic regulation. Anesthesia lowers blood pressure and heart rate (HR), whereas surgical intervention has opposing effects. The interaction of anesthesia and surgical intervention on hemodynamics in diabetes is unknown, despite being a potential perioperative risk factor. We aimed to determine the effect of diabetes on the integrative interaction between hemodynamics, anesthesia, and surgical incision. Zucker type 2 diabetic rats (DM) and their nondiabetic littermates (ND) were implanted with an intravenous port for drug delivery, and a radiotelemeter to measure mean arterial blood pressure (MAP) and derive HR (total n = 50). Hemodynamic pharmacological responses were assessed under conscious, isoflurane anesthesia (~2–2.5%), and anesthesia–surgical conditions; the latter performed as a laparotomy. MAP was not different between groups under conscious conditions (ND 120 ± 6 vs. DM 131 ± 4 mmHg, P > 0.05). Anesthesia reduced MAP, but not differently in DM (ND −30 ± 6 vs. DM −38 ± 4 ΔmmHg, P > 0.05). Despite adequate anesthesia, surgical incision increased MAP, which tended to be less in DM (ND +21 ± 4 vs. DM +13 ± 2 ΔmmHg, P = 0.052). Anesthesia disrupted central baroreflex HR responses to sympathetic activation (sodium nitroprusside 10 μg·kg−1, ND conscious 83 ± 13 vs. anesthetized 16 ± 5 Δbpm; P < 0.05) or to sympathetic withdrawal (phenylephrine 10 μg·kg−1, ND conscious −168 ± 37 vs. anesthetized −20 ± 6 Δbpm; P < 0.05) with no additional changes observed after surgical incision or during diabetes. During perioperative conditions, type 2 diabetes did not impact on short‐term hemodynamic regulation. Anesthesia had the largest hemodynamic impact, whereas surgical effects were limited to modulation of baseline blood pressure.

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Section: Discussionmentioning

confidence: 99%

Effect of type 2 diabetes, surgical incision, and volatile anesthesia on hemodynamics in the rat

Bussey

Lamberts

2017

Physiol Rep

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“…Therefore, the excess systemic and gut mucosal lactate production seen during CPB may result from an inflammatory effect causing mitochondrial dysfunction. Regional impairment and redistribution of blood flow within the layers of the gut wall during CPB may also be a contributing factor to local lactate production [35]. Others have suggested that increased production of lactate in the gut tissue contributes to increased systemic lactate concentrations in CPB patients [36].…”

Section: Discussionmentioning

confidence: 99%

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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SummaryThe aim of this prospective study was to determine the feasibility of intestinal endoluminal microdialysis as a new method for clinical monitoring of the adequacy of splanchnic perfusion in the large bowel. A microdialysis catheter for continuous lactate, glycerol, glucose and pyruvate measurements attached to a tonometric catheter was placed into the lumen of the recto-sigmoid junction prior to surgery in 13 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Lactate was also measured in blood and muscle. CPB was associated with a 10-fold increase in luminal lactate from 0.16 (0.01) to 1.67 (0.38) mmol.l )1 (p < 0.001). Muscular lactate increased from baseline levels 1.20 (0.21) to 1.77 (0.36) mmol.l )1 during CPB (p = 0.01), but the muscular lactate-pyruvate ratio remained unchanged. Arterial lactate increased only slightly from 0.9 (0.05) to 1.1 (0.06) mmol.l )1 (p = 0.027) during CPB. Increased lactate concentrations in the large bowel during CPB are suggestive of local lactate production consistent with impaired oxygen delivery. Intestinal endoluminal microdialysis is a potential clinically applicable method for monitoring intestinal metabolism. Combined with tonometry, microdialysis provides the opportunity to monitor both circulation and metabolism in the rectal mucosa. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk of developing intestinal mucosal ischaemia, leading to disturbed mucosal integrity and increased intestinal permeability [1]. The latter may result in leakage of endotoxins into the circulation contributing to systemic inflammation observed during CPB [2]. The most likely cause of increased intestinal vascular permeability is imbalance between splanchnic oxygen supply and demand [3].There are currently few reliable methods available for monitoring adequacy of splanchnic perfusion during CPB. If available, these data could lead to strategies being developed to reduce intestinal ischaemia and the resulting increased mucosal permeability. Gastric tonometry is the only clinically available method that allows monitoring of gastro-intestinal perfusion. Even though in cardiac [4,5] and high-risk surgical patients [6] peri-operative tonometry-derived variables are predictive

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“…Experimental and clinical studies underline that microcirculation and/or tissue oxygenation are impaired during cardiac surgery. This impairment appears to be transient and resolves early in the postoperative hours.…”

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confidence: 99%

Tissue near infra red spectroscopy change is not correlated with patients' outcome in elective cardiac surgery

Morel

Bouchet

Vola

et al. 2014

Acta Anaesthesiol Scand

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Dopexamine attenuates microvascular perfusion injury of the small bowel in pigs induced by extracorporeal circulation

Abstract: Our data demonstrate that treatment with the vasoactive drug dopexamine leads to a significant reduction of the perfusion injury of the small bowel.

Cited by 17 publications

References 25 publications

Effect of type 2 diabetes, surgical incision, and volatile anesthesia on hemodynamics in the rat

Effect of type 2 diabetes, surgical incision, and volatile anesthesia on hemodynamics in the rat

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

Tissue near infra red spectroscopy change is not correlated with patients' outcome in elective cardiac surgery

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