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Systemic and regional effects of supraceliac aortic occlusion during experimental hepatic vascular exclusion
Ruy J Cruz1, Luiz F Poli de Figueiredo, Jose L M Braz
1Division of Applied Physiology, Heart Institute-InCor, and Department of Surgery, University of São Paulo Medical School, Rua Marivaldo Fernandes, 140, São Paulo, SP 04792-060, Brazil. expcruzjr@incor.usp.br
Background:
Supraceliac aortic occlusion (AO) has been recommended to avoid hypotension during hepatic vascular exclusion (HVE). We hypothesized that AO may negatively affect splanchnic perfusion during HVE.
Methods:
Twenty-six dogs (16 +/- 0.3 kg) were randomly assigned to HVE (n = 13) or HVE+AO (n = 13), during 30 minutes followed by a 60-minute reperfusion period. Cardiac output (CO), mean arterial pressure (MAP), superior mesenteric artery blood flow (SMABF, ultrasonic flowprobe), gastric mucosal PCO(2) (gas tonometry) and PCO(2)-gap were evaluated.
Results:
HVE alone induced decreases in MAP from 115 +/- 5.1 to 26 +/- 1 mm Hg, in CO from 2.0 +/- 0.1 to 0.4 +/- 0.1 L/min and SMABF from 398 +/- 42 to 16 +/- 7.6 mL/min, while PCO(2) gap increased from 4 +/- 3.7 to 52 +/- 5.4 mm Hg. Supraceliac aortic occlusion only avoided severe hypotension. During reperfusion MAP, CO, and SMABF were partially restored, while PCO(2) gap showed no improvements in either group.
Conclusions:
HVE promotes major systemic and splanchnic perfusional derangement. Concomitant AO may avoid HVE-induced hypotension without producing further deleterious effects.