Relative Importance of Flow versus  Pressure in Splanchnic Perfusion during Cardiopulmonary Bypass in Rabbits

Bastien, Olivier; Piriou, Vincent; Aouifi, A.; Flamens, C.; Evans, Rhys; Lehot, J.J.

doi:10.1097/00000542-200002000-00028

Cited by 33 publications

(18 citation statements)

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“…After the authorization of the Health Authority and approval of the University Research Committee, in an authorized animal care laboratory (Toxicology Research Laboratory "F. Gorgone," Whyeth Lederle, Catania, Italy), 20 New Zealand white rabbits, all males, weighing 3.690 ± 0.587 kg (range, 2.6-5.3 kg) were divided into three groups [1][2][3][4][5] :…”

Section: Methodsmentioning

confidence: 99%

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Experimental anaesthesiologic protocol for porto‐intracaval shunt for liver total vascular exclusion: Preliminary study in the rabbit

et al. 2001

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The aim of this study was to evaluate the effects and interference of different anaesthetic techniques in rabbits undergoing liver total vascular exclusion using a porto-intracaval shunt. Twenty New Zealand rabbits were divided in three groups: group A receiving diazepam as premedication, ketamine + atropine for induction and maintenance of anaesthesia and undergoing a porto-intracaval shunt operation; group B receiving midazolam as premedication, ketamine + fentanyl + atropine for induction and maintenance of anaesthesia and undergoing a porto-intracaval shunt operation; group C receiving the same drugs as group B but undergoing a simple portal and caval clamping. The following parameters were studied: efficacy of premedication, vital parameters before and after clamping and insertion of the shunt, mean time to clamp and insert the shunt, mean survival time after clamping (group C) or activation of the shunt (groups A and B). Midazolam was significantly better for premedication; there was no statistically significant difference between groups A and B for the vital parameters, for the time necessary to clamp and insert the shunt, for the intraoperative course, and for the mean survival time. The absence of a statistically significant difference between groups could be due to the low number of animals used in the study. There is actually evidence that a correct anaesthesiologic protocol, especially referring to analgesia and fluid management, improves the outcome of operated animals. Surely further studies, possibly conducted on a larger number of animals, are required to evaluate better the results observed and to consider applying these data and this experience to humans.

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Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5][6]8 Fluids were administered in reason of 10 mL/kg −1 /h −1 , and a 250-UI bolus of heparin was administered intravenously 3 to 5 minutes before insertion of the shunt in rabbits of both group A and B (2,3,7). The shunt was a selfconstructed 7-French polyurethane shunt modelled as an inverted Y.…”

Section: Methodsmentioning

confidence: 99%

Experimental anaesthesiologic protocol for porto‐intracaval shunt for liver total vascular exclusion: Preliminary study in the rabbit

et al. 2001

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“…[1] This is a reason that can explain why cardiac centers differ their protocols regarding to what the optimal blood flow or blood pressure should be during CPB. [2] However, the optimal perfusion should be defined by the outcome on the patient and particularly in terms of brain, kidney, gut function along with optimum respiratory function. [1] The relationship between blood flow and blood pressure can be described by the relationship: F=ΔP/R, where F is the blood flow, ΔP is the perfusion pressure, which is the pressure difference between two points of a blood vessel or an organ, and R is the resistance to flow across this blood vessel or organ.…”

Section: Blood Flow and Blood Pressure: An Interactive Relationshipmentioning

confidence: 99%

“…A study that compared the importance of flow versus pressure during CPB in rabbits using laser Doppler flowmetry showed that the low splanchnic perfusion during CPB in mainly reliant on the pump blood flow. [2] Perfusion pressure was of secondary importance. Furthermore, Adluri and his colleagues found that the reduced hepatic blood flow when commencing CPB can be balanced by an increase of the pump flow rate by 20%.…”

Section: Blood Flow During Cpb: Goals and Requirementsmentioning

confidence: 99%

Advanced Perfusion Techniques - Flow versus Pressure

Pappa¹,

Theodosiadis²,

Paliouras³

et al. 2017

J. Biomed

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Cardiac operations which require Cardiopulmonary bypass (CPB) are considered the most common procedures in cardiac surgery, performed for more than half a century, especially in Europe and North America. Despite that new technologies are being incorporated in CPB as long as the development of new techniques in CPB, some debates still remain. These debates regard the achievement of the needed optimal perfusion during CPB and the relation between perfusion pressures and the optimal blood flow during extracorporeal circulation. Blood flow and blood pressure during Cardiopulmonary bypass are very important factors. Although more studies are in favor of a minor superiority of the optimal blood flow requirements, compared to the corresponding optimal blood pressure needs, their role is quite interdependent. The usage of contemporary electronic Data Management Systems (DMS) led to a significant evolution of the perfusion science. Adequate perfusion can now be judged by its results in real time, while information from DMS, such as venous saturation, levels of haemoglobin and lactate, may be used as the markers of optimal perfusion and additionally for the development of the perfusion protocols in the future.

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“…While group I showed a similar vascular response and small intestinal PO 2 ratio to group C, the serum PG concentration increased only in group C. Therefore, we do not believe that this reduced intestinal blood fl ow was the direct cause of BT in this study. Generally speaking, blood fl ow to the jejunal and ileal mucosa during CPB was only about one third of pre-CPB blood fl ow [17] , and regional redistribution diminished oxygenation of the intestinal mucosa [18] and impaired gut barrier function and small bowel transcellular transport [19] . Based on these previous fi ndings, our model in which blood fl ow during stenosis was maintained at two thirds of the preoperative value might be insuffi cient in simulating CPB blood fl ow.…”

Section: Pitavastatin Prevents Bacterial Translocationmentioning

confidence: 99%

Pitavastatin Prevents Bacterial Translocation after Nonpulsatile/Low-Pressure Blood Flow in Early Atherosclerotic Rat: Inhibition of Small Intestine Inducible Nitric Oxide Synthase

Tsunooka

Nakagawa²,

Doi³

et al. 2005

Eur Surg Res

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Background: Cardiopulmonary bypass decreases intestinal mucosal blood flow because of nonpulsatile and low-pressure blood flow resulting in bacterial translocation (BT) and atherosclerosis also has peripheral blood flow deficiency. The risk of nonpulsatile and low-pressure blood flow for atherosclerotic animals and the effect of statin administration, which has pleiotropic effects, were studied. Methods: Wistar rats were divided into four groups: group N (normal diet), group C (high-cholesterol diet), group S (group C plus pitavastatin therapy), and group I [group C plus inducible nitric oxide (iNOS) inhibitor therapy]. First of all, vascular responses were measured. Then the rats underwent nonpulsatile/low-pressure blood flow in the intestine, and the serum peptidoglycan concentration as a parameter of BT, the small intestinal PO₂ ratio (intestinal PO₂/PaO₂) as a parameter of mucosal blood flow, and NO concentrations were measured before surgery (T0), at the end of 90 min of stenosis (T1), and 90 min after the release of stenosis (T2). Immunostaining for nitrotyrosine was also performed at T2. Results: Group C had vascular endothelial dysfunction without histological changes, which indicated early atherosclerosis. The serum peptidoglycan concentration increased significantly at T2 only in group C. The intestinal PO₂ ratio was decreased at T1 in all the groups, and retuned to baseline at T2 in group N and group S, but not in group C or group I. Jejunal NO only in group C was significantly higher at all time points and ileal NO production at T1 and T2. There tended to be a positive stain for nitrotyrosine along the mucosal epithelium in group C. Conclusion: In the setting of early atherosclerosis, intestinal blood flow does not only improve after nonpulsatile/low-pressure blood flow but causes BT because of a large amount of NO from high enzymatic intestinal iNOS activity, and pitavastatin treatment can prevent BT by improving both issues.

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Relative Importance of Flow versus Pressure in Splanchnic Perfusion during Cardiopulmonary Bypass in Rabbits

Abstract: Prevention of splanchnic ischemia during CPB should focus on preservation of high CPB blood flow rather than on high pressure.

Cited by 33 publications

References 0 publications

Experimental anaesthesiologic protocol for porto‐intracaval shunt for liver total vascular exclusion: Preliminary study in the rabbit

Experimental anaesthesiologic protocol for porto‐intracaval shunt for liver total vascular exclusion: Preliminary study in the rabbit

Advanced Perfusion Techniques - Flow versus Pressure

Pitavastatin Prevents Bacterial Translocation after Nonpulsatile/Low-Pressure Blood Flow in Early Atherosclerotic Rat: Inhibition of Small Intestine Inducible Nitric Oxide Synthase

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