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Gut mucosal perfusion in infants undergoing cardiopulmonary bypass: effect of preoperative captopril
P D Booker1, A J Davis, R Franks
1Royal Liverpool Children's NHS Trust.
Insights
Captopril did not improve gut mucosal perfusion in infants undergoing cardiopulmonary bypass (CPB). This study found no significant differences in tissue perfusion or blood pressure between infants who received captopril and those who did not.
Area of Science:
- Pediatric Surgery
- Cardiovascular Surgery
- Pharmacology
Background:
- Infants undergoing cardiopulmonary bypass (CPB) are at risk for compromised gut mucosal perfusion.
- Angiotensin converting enzyme (ACE) inhibitors like captopril are sometimes used to improve perfusion, but their efficacy in this population is not well-established.
Purpose of the Study:
- To investigate the effect of preoperative captopril administration on gut mucosal perfusion in infants undergoing CPB.
Main Methods:
- A study involving 24 infants (0.7-45 weeks) requiring CPB.
- One group received oral captopril pre-anesthesia; the control group did not.
- Gut mucosal perfusion was assessed using gastric intramucosal pH (pHi) and rectal mucosal flux (laser Doppler flowmetry).
- Arterial pressure, base deficit, lactate, and pyruvate were also monitored.
Main Results:
- No significant differences in femoral arterial pressure were observed between the captopril and control groups.
- No significant differences in regional or global tissue perfusion measures were found between the groups.
- Captopril administration did not demonstrate a beneficial effect on gut mucosal perfusion.
Conclusions:
- Preoperative captopril does not appear to improve gut mucosal perfusion in infants undergoing hypothermic, non-pulsatile CPB.
- Further research may be needed to explore other interventions for optimizing perfusion in this patient group.
Abstract:
We have studied gut mucosal perfusion in 24 infants, aged 0.7-45 weeks, requiring cardiopulmonary bypass (CPB). Group 2 patients (n = 12) had received the angiotensin converting enzyme inhibitor captopril 0.8-0.9 mg kg-1 orally, 45 min before induction of anaesthesia. Group 1 infants were of similar age and size and required a similar duration of CPB, but did not receive any preoperative medication. An orogastric tonometer allowed intermittent calculations of gastric intramucosal pH (pHi), and rectal mucosal perfusion ("flux") was monitored using laser Doppler flowmetry. Measurements of arterial base deficit and lactate and pyruvate concentrations were made intermittently. We found no significant difference in femoral arterial pressure between the groups at any time before, during or after surgery. Similarly, we found no significant differences in our measures of regional or global tissue perfusion between the groups at any time before, during or after surgery. We conclude that preoperative administration of captopril produced no beneficial effect on gut mucosal perfusion in infants undergoing hypothermic, non-pulsatile CPB.
