| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 433.39 KB | Adobe PDF |
Advisor(s)
Abstract(s)
Background and Goal of Study: Perioperative and intraoperative hypovolemia may cause intestinal hypoperfusion and postoperative complications 1 . The objective of this study is to analyse the ef fect on the small bowel m of HES 130/0.4 and Ringer solutions used for volume replacement after se-vere haemorrhage in pigs. Materials and Methods: Six Large White pigs under TIVA with propofol 15 mg/kg/h and remifentanil 0.3 ug/kg/h; 25 ml/kg of arterial blood was removed during 20 minutes from each pig. Blood volume was replaced at 999 ml/h, 20 minutes after the end of the bleeding as follows: Gr1- three pigs, volume was replaced with 25 ml/kg Ringer; Gr2- three pigs, the volume was replaced with 20 ml/kg HES 130/0.4. Pigs were maintained under the same TIVA for an ad-ditional one hour before euthanasia with 40 mEq of KCl. Small bowel samples were collected and a) semiquantitative parameters oedema, congestion, hy-peraemia, haemorrhage, inflammatory infiltration, cellular degeneration and necrosis, and b) the epithelial detachment were evaluated and classified in a specific scale from 0 to 3 2 , and 0 to 5 3,4 , respectively. The quantitative morpho-logical assessment to mucosal loss (ML) percentage and crypt:interstitium ratio (C:I) was also analysed. Mean arterial pressure (MAP) and heart rate (HR) were analysed. Results and Discussion: Gr1- MAP decreased 60% from baseline (69.3±3.8 mmHg to 27.7±4.2 mmHg); ML percentage was 2.18±0.46% (duodenum), 0.62±1.07% (jejunum) and 0.45±0.77% (ileum); the C:I was 0.5±0.06% (duodenum), 0.49±0.02% (jejunum) and 0.46±0.09% (ileum). Gr2- MAP decreased 71% from baseline (78.7±18.9 mmHg to 22.7±0.1 mmHg); ML percentage was 0.75±1.3% (duodenum), 0.0±0.0% (jejunum) and 0.0±0.0% (ileum); the C:I was 0.73±0.28% (duodenum), 0.48±0.11% (jejunum) and 0.43±0.12% (ileum). C:I ratio did not presented relevant dif ferences among the Groups. There were no significant changes in HR in both groups. Conclusions: Volume replacement with HES 130/0.4 may reduce the ML in the small bowel after severe haemorrhage, when compared to using Ringer Lactate. Duodenum mucosa seems to be more sensitive to hypoperfusion than jejunum and ileum mucosa.
Description
Keywords
intestinal hypoperfusion Perioperative hypovolemia intraoperative hypovolem pig small bowel severe haemorrhage Ringer Lactate HES
Citation
Oliveira A, Venâncio C, Silva A, Souza A, Vala H, Ferreira D (2011). Volume replacement with Hydroxyethyl Starch (HES) 130/0.4 and Ringer Lactate solution in pigs after severe haemorrhage: a small bowel mucosa preliminary study. European Journal of Anaesthesiology. 28(Suppl 48): 44