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dc.contributor.authorHiltebrand, Luzius B
dc.contributor.authorKoepfli, Eliana
dc.contributor.authorKimberger, Oliver
dc.contributor.authorSigurdsson, Gisli H
dc.contributor.authorBrandt, Sebastian
dc.date.accessioned2011-03-04T09:45:52Z
dc.date.available2011-03-04T09:45:52Z
dc.date.issued2011-03
dc.date.submitted2011-03-04
dc.identifier.citationAnesthesiology. 2011, 114(3):557-64en
dc.identifier.issn1528-1175
dc.identifier.pmid21307765
dc.identifier.doi10.1097/ALN.0b013e31820bfc81
dc.identifier.urihttp://hdl.handle.net/2336/123610
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND:: Vasopressors, such as norepinephrine, are frequently used to treat perioperative hypotension. Increasing perfusion pressure with norepinephrine may increase blood flow in regions at risk. However, the resulting vasoconstriction could deteriorate microcirculatory blood flow in the intestinal tract and kidneys. This animal study was designed to investigate the effects of treating perioperative hypotension with norepinephrine during laparotomy with low fluid volume replacement. METHODS:: Twenty anesthetized and ventilated pigs were randomly assigned to a control or treatment (norepinephrine) group. Both groups received 3 ml · kg · h Ringer's lactate solution. In addition, the norepinephrine group received norepinephrine to stepwise increase blood pressure to 65 and 75 mmHg. Regional blood flow was measured in the splanchnic arteries. In the small bowel and colon, microcirculatory blood flow was measured using laser Doppler flowmetry. Intestinal tissue oxygen tension was measured with intramural Clark-type electrodes. RESULTS:: Hepatosplanchnic and kidney blood flow remained unchanged after reversal of arterial hypotension to a mean arterial pressure of 75 mmHg with norepinephrine. For the norepinephrine group versus the control group, the mean ± SD microcirculatory blood flow in the jejunum (96 ± 41% vs. 93 ± 18%) and colon (98 ± 19% vs. 97 ± 28%) and intestinal tissue oxygen tension (jejunum, 45 ± 13 vs. 43 ± 5 mmHg; colon, 50 ± 10 vs. 45 ± 8 mmHg) were comparable. CONCLUSIONS:: In this model of abdominal surgery in which clinical conditions were imitated as close as possible, treatment of perioperative hypotension with norepinephrine had no adverse effects on microcirculatory blood flow or tissue oxygen tension in the intestinal tract.
dc.languageENG
dc.language.isoenen
dc.publisherLippincott Williams & Wilkinsen
dc.relation.urlhttp://dx.doi.org/10.1097/ALN.0b013e31820bfc81en
dc.subject.meshAbdomen/surgeryen
dc.subject.meshAnimals
dc.subject.meshCardiac Output
dc.subject.meshDose-Response Relationship, Drug
dc.subject.meshHemodynamics
dc.subject.meshHemoglobins
dc.subject.meshHypotension
dc.subject.meshIntestines
dc.subject.meshIntraoperative Complications
dc.subject.meshLaparotomy
dc.subject.meshLaser-Doppler Flowmetry
dc.subject.meshMicrocirculation
dc.subject.meshNorepinephrine
dc.subject.meshOxygen Consumption
dc.subject.meshRegional Blood Flow
dc.subject.meshRespiratory Mechanics
dc.subject.meshSplanchnic Circulation
dc.subject.meshSwine
dc.subject.meshVasoconstrictor Agents
dc.titleHypotension during fluid-restricted abdominal surgery: effects of norepinephrine treatment on regional and microcirculatory blood flow in the intestinal tracten
dc.typeArticleen
dc.contributor.departmentHead of the Department of Anesthesiology and Pain Therapy, Regional Hospital Emmental and University of Bern, Bern, Switzerland; Resident, Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, Switzerland; ‡ Attending Physician, Department of Anesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Vienna, Austria; § Professor and Chairman, Department of Anesthesia and Intensive Care Medicine, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland.en
dc.identifier.journalAnesthesiologyen
html.description.abstractBACKGROUND:: Vasopressors, such as norepinephrine, are frequently used to treat perioperative hypotension. Increasing perfusion pressure with norepinephrine may increase blood flow in regions at risk. However, the resulting vasoconstriction could deteriorate microcirculatory blood flow in the intestinal tract and kidneys. This animal study was designed to investigate the effects of treating perioperative hypotension with norepinephrine during laparotomy with low fluid volume replacement. METHODS:: Twenty anesthetized and ventilated pigs were randomly assigned to a control or treatment (norepinephrine) group. Both groups received 3 ml · kg · h Ringer's lactate solution. In addition, the norepinephrine group received norepinephrine to stepwise increase blood pressure to 65 and 75 mmHg. Regional blood flow was measured in the splanchnic arteries. In the small bowel and colon, microcirculatory blood flow was measured using laser Doppler flowmetry. Intestinal tissue oxygen tension was measured with intramural Clark-type electrodes. RESULTS:: Hepatosplanchnic and kidney blood flow remained unchanged after reversal of arterial hypotension to a mean arterial pressure of 75 mmHg with norepinephrine. For the norepinephrine group versus the control group, the mean ± SD microcirculatory blood flow in the jejunum (96 ± 41% vs. 93 ± 18%) and colon (98 ± 19% vs. 97 ± 28%) and intestinal tissue oxygen tension (jejunum, 45 ± 13 vs. 43 ± 5 mmHg; colon, 50 ± 10 vs. 45 ± 8 mmHg) were comparable. CONCLUSIONS:: In this model of abdominal surgery in which clinical conditions were imitated as close as possible, treatment of perioperative hypotension with norepinephrine had no adverse effects on microcirculatory blood flow or tissue oxygen tension in the intestinal tract.


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