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Published on: August 5, 2012
Influence of steroids on microvascular perfusion injury of the bowel induced by extracorporeal circulation
F U Sack1, B Reidenbach, R Dollner
1Department of Cardiac Surgery, University of Heidelberg, Germany. falk-udo.sack@urz.uni-heidelberg.de
Background:
Extracorporeal circulation is associated with gastrointestinal complications. By means of intravital microscopic methods, we investigated whether preoperative treatment with steroids can attenuate the impairment of the bowel microcirculation.
Methods:
In 20 pigs, a partial left heart bypass (pLHB) was established. A loop of the terminal ileum was exteriorized for intravital-microscopic observation. Seven sham-operated animals served as controls. In 13 animals, pLHB was established for 2 hours with a flow rate of 2,000 mL per minute; 7 of the animals received 20 mg/kg body weight prednisolone preoperatively. The microcirculatory network was analyzed before, during pLHB, and 2 hours after bypass.
Results:
Despite unchanged macro-hemodynamics, pLHB resulted in a significant microvascular perfusion injury of the small bowel. Arteriolar vasoconstriction and a reduction of perfused capillaries per unit area (functional capillary density) to 30% of prebypass values could be found. Blood cell velocities were reduced in submucuous collecting venules. In the steroid-treated animals, the functional capillary density remained normal. In addition, arteriolar vasoconstriction could be prevented.
Conclusions:
Treatment with prednisolone largely prevents the microcirculatory alterations in the small bowel induced by extracorporeal circulation.
