Elsevier

Cardiovascular Surgery

Volume 10, Issue 2, April 2002, Pages 128-133
Cardiovascular Surgery

Splanchnic oxygenation in patients undergoing abdominal aortic aneurysm repair and volume expansion with eloHAES

https://doi.org/10.1016/S0967-2109(01)00132-6Get rights and content

Abstract

Background: Gastric intramucosal pH (pHi), a surrogate marker of splanchnic oxygenation, falls following abdominal aortic aneurysm surgery.

Aim: To investigate the effects of volume expansion with hydroxyethyl starch (eloHAES) on splanchnic perfusion compared to another colloid such as gelofusine.

Patients and methods: Twenty-two consecutive patients undergoing AAA repair were randomised to receive either eloHAES or gelofusine as plasma expanders. Tissue oxygenation was monitored (10 gelofusine and 12 eloHAES) indirectly by measuring pHi using a nasogastric tonometer.

Results: Compared to the eloHAES group, the fall in pHi was significantly greater in the gelofusine group at clamp release (7.29 vs 7.33, P=0.003) and at 4 h following clamp release (7.29 vs 7.33, P=0.03). There was a good inverse correlation between the lowest pHi and the peak serum interleukin-6 (rs=−0.47, P=0.03). By multivariate analysis, the only factor that influenced the pHi was the type of colloid used (F=5.54, P=0.005). The eloHAES treated patients required significantly less colloid on the first postoperative day (3175±175 vs 4065±269 ml, P=0.01).

Conclusion: In patients undergoing abdominal aortic aneurysm repair, plasma expansion with eloHAES improves microvascular perfusion and splanchnic oxygenation.

Section snippets

Patients and methods

Informed consent was obtained from 22 consecutive patients scheduled for elective aneurysm surgery. Patients were randomised to receive either hydroxyethyl starch (eloHAES) (Fresinius, UK) or gelofusine as colloid during surgery and postoperatively. Tissue oxygenation was monitored indirectly by measuring pHi using a nasogastric tonometer (TRIP® tonometry catheter, Datex, Helsinki, Finland). All study patients received 300 mg of ranitidine orally eight hours before surgery to improve the

Results

Randomisation resulted in two groups of patients who were matched for age and sex. The duration of the operation and the aortic cross clamp times were comparable in the two groups of patient studied (Table 1). Patients treated with gelofusine required a significantly larger volume of colloid to maintain the central venous pressure and mean arterial pressure postoperatively (4065±269 ml in the gelofusine group vs 3175±175 ml in the eloHAES group, P=0.01). The requirements for crystalloid was

Discussion

This study demonstrates a clear relationship between the choice of colloid for plasma expansion during aortic aneurysm surgery and splanchnic perfusion as determined by gastric pHi. Patients resuscitated with hydroxyethyl starch required significantly less colloid and were able to maintain splanchnic perfusion to a greater extent than patients resuscitated with gelofusine. Marik et al. showed that patients resuscitated with hydroxyethyl starch during elective aortic aneurysm repair required

References (50)

  • G.W Machiedo et al.

    Patterns of mortality in a surgical intensive care unit

    Surgical Gynecology and Obstetrics

    (1981)
  • R.J Goris et al.

    Multiple-organ failure. Generalized autodestructive inflammation?

    Archives of Surgery

    (1985)
  • N.S Ambrose et al.

    Incidence of pathogenic bacteria from mesenteric lymph nodes and ileal serosa during Crohn's disease surgery

    British Journal of Surgery

    (1984)
  • D.W Wilmore et al.

    The gut: a central organ after surgical stress

    Surgery

    (1988)
  • K Maejima et al.

    Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury

    Infection and Immunity

    (1984)
  • E.A Deitch et al.

    Hemorrhagic shock-induced bacterial translocation is reduced by xanthine oxidase inhibition or inactivation

    Surgery

    (1988)
  • J.R Border et al.

    The gut origin septic states in blunt multiple trauma (ISS=40) in the ICU

    Annals of Surgery

    (1987)
  • D.L Dyess et al.

    Candida sepsis. Implications of polymicrobial blood-borne infection

    Archives of Surgery

    (1985)
  • R.A Rozenfeld et al.

    Methods for detecting local intestinal ischemic anaerobic metabolic acidosis by PCO2

    Journal of Applied Physiology

    (1996)
  • M Bjorck et al.

    Early detection of major complications after abdominal aortic surgery: predictive value of sigmoid colon and gastric intramucosal pH monitoring

    British Journal of Surgery

    (1994)
  • E Berendes et al.

    Effects of dopexamine on creatinine clearance, systemic inflammation, and splanchnic oxygenation in patients undergoing coronary artery bypass grafting

    Anesthesia and Analgesics

    (1997)
  • K.J Tracey et al.

    Cachetin/TNF-alpha in septic shock and septic adult respiratory distress syndrome

    American Review of Respiratory Disease

    (1988)
  • K.E Stephens et al.

    Tumor necrosis factor causes increased pulmonary permeability and edema. Comparison to septic acute lung injury

    American Review of Respiratory Disease

    (1988)
  • R.A Lewis et al.

    Leukotrienes and other products of the 5-lipoxygenase pathway. Biochemistry and relation to pathobiology in human diseases

    New England Journal of Medicine

    (1990)
  • E.C Rackow et al.

    Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock

    Critical Care Medicine

    (1983)
  • Cited by (3)

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