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A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

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Rectal microcirculatory alterations after elective on-pump cardiac surgery.

E C Boerma¹, K Kaiferová, A J M Konijn

¹Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. e.boerma@chello.nl

Minerva Anestesiologica

|June 29, 2011

Summary

On-pump cardiac surgery can alter intestinal microcirculation. Direct observation revealed reduced rectal mucosal perfusion in over half of patients, though overall blood flow and oxygenation remained largely unaffected.

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Area of Science:

Cardiovascular Surgery
Gastroenterology
Critical Care Medicine

Background:

On-pump cardiac surgery is associated with hemodynamic changes that may impair intestinal perfusion.
Previous assessments relied on indirect methods like tonometry and microdialysis.
Direct in vivo observation of intestinal microcirculation was previously limited.

Purpose of the Study:

To determine the incidence of intestinal microvascular alterations after on-pump cardiac surgery.
To utilize direct in vivo observation for assessing rectal microcirculation.
To correlate microvascular findings with gas tonometry data.

Main Methods:

Prospective observational study in elective on-pump cardiac surgery patients.
Simultaneous sidestream dark field (SDF) imaging and automated gas tonometry in the rectal pouch.
Measurements performed within 30 minutes of ICU admission.

Main Results:

The median proportion of perfused vessels (PPV) in the rectal mucosa was 85%.
54% of patients exhibited a PPV below 90%.
Rectal microcirculatory blood flow index was largely preserved; 7% showed a significant rectal-to-arterial pCO(2) gap.

Conclusions:

Direct rectal mucosal observation shows impaired microvascular perfusion in over half of patients post-cardiac surgery.
Despite reduced perfusion, overall rectal microcirculatory blood flow and gas exchange suggest adequate oxygenation in most patients.
Combining SDF imaging and tonometry provides a comprehensive assessment of intestinal perfusion post-cardiac surgery.