Aortic Cross-Clamping and Reperfusion in Pigs Reduces Microvascular Oxygenation by Altered Systemic and Regional Blood Flow Distribution

• Published in: Anesthesia and analgesia Vol. 111; no. 2; pp. 345 - 353
• Main Authors: SIEGEMUND, Martin, VAN BOMMEL, Jasper, STEGENGA, Michiel E, STUDER, Wolfgang, VAN ITERSON, Mat, ANNAHEIM, Sandra, MEBAZAA, Alexandre, INCE, Can
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.08.2010
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Aorta - surgery; Biological and medical sciences; Carbon Dioxide - blood; Constriction; Disease Models, Animal; Hyperemia - blood; Hyperemia - physiopathology; Ileum - blood supply; Kidney - blood supply; Male; Medical sciences; Microcirculation; Oxygen - blood; Partial Pressure; Regional Blood Flow; Renal Circulation; Reperfusion; Reperfusion Injury - blood; Reperfusion Injury - etiology; Reperfusion Injury - physiopathology; Splanchnic Circulation; Swine; Time Factors; Regional blood flow; Vertebrata; Mammalia; Reperfusion; Anesthesia; Aorta; Artiodactyla; Oxygenation; Ungulata; Pig
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ane.0b013e3181e4255f

In this study, we tested the hypothesis that aortic cross-clamping (ACC) and reperfusion cause distributive alterations of oxygenation and perfusion in the microcirculation of the gut and kidneys despite normal systemic hemodynamics and oxygenation. Fifteen anesthetized pigs were randomized between an ACC group (n = 10), undergoing 45 minutes of aortic clamping above the superior mesenteric artery, and a time-matched sham surgery control group (n = 5). Systemic, intestinal, and renal hemodynamics and oxygenation variables were monitored during 4 hours of reperfusion. Microvascular oxygen partial pressure (microPo(2)) was measured in the intestinal serosa and mucosa and the renal cortex, using the Pd-porphyrin phosphorescence technique. Intestinal luminal Pco(2) was determined by air tonometry and the serosal microvascular flow by orthogonal polarization spectral imaging. Organ blood flow and renal and intestinal microPo(2) decreased significantly during ACC, whereas the intestinal oxygen extraction and Pco(2) gap increased. The intestinal response to reperfusion after ACC was a sustained reactive hyperemia but no such effect was seen in the kidney. Despite a sustained high intestinal O(2) delivery, serosal microPo(2) (median [range], 49 mm Hg [41-67 mm Hg] versus 37 mm Hg [27-41 mm Hg]; P < 0.05 baseline versus 4 hours reperfusion) and the absolute number of perfused microvessels decreased along with an increased intestinal Pco(2) gap (17 mm Hg [10-19 mm Hg] versus 23 mm Hg [19-30 mm Hg]; P < 0.05). In contrast, the kidney showed a progressive O(2) delivery decrease accompanied by a decrease in renal cortex oxygenation (70 mm Hg [52-93 mm Hg] versus 57 mm Hg [33-64 mm Hg]; P < 0.05). Increased systemic and regional blood flow and oxygen supply after ACC does not ensure adequate regional blood flow and microcirculatory oxygenation in all organs.