22 research outputs found
Hematócrito baixo compromete a remoção de CO2 da mucosa gástrica na hemodiluição normovolêmica intensa experimental
OBJECTIVE: The net effects of acute normovolemic hemodilution with different hemoglobin levels on splanchnic perfusion have not been elucidated. The hypothesis that during moderate and severe normovolemic hemodilution, systemic and splanchnic hemodynamic parameters, oxygen-derived variables, and biochemical markers of anaerobic metabolism do not reflect the adequacy of gastric mucosa, was tested in this study. METHODS: Twenty one anesthetized mongrel dogs (16 ± 1 kg) were randomized to controls (CT, n = 7, no hemodilution), moderate hemodilution (hematocrit 2 5% ± 3%, n = 7) or severe hemodilution (severe hemodilution, hematocrit 15% ± 3%, n = 7), through an isovolemic exchange of whole blood and 6% hydroxyethyl starch, at a 20 mL/min rate, to the target hematocrit. The animals were followed for 120 min after hemodilution. Cardiac output (CO, L/min), portal vein blood flow (PVF, mL/min), portal vein-arterial and gastric mucosa-arterial CO2 gradients (PV-artCO2 and PCO2 gap, mm Hg, respectively) were measured throughout the experiment. RESULTS: Exchange blood volumes were 33.9 ± 3.3 and 61.5 ± 5.8 mL/kg for moderate hemodilution and severe hemodilution, respectively. Arterial pressure and systemic and regional lactate levels remained stable in all groups. There were initial increases in cardiac output and portal vein blood flow in both moderate hemodilution and severe hemodilution; systemic and regional oxygen consumption remained stable largely due to increases in oxygen extraction rate. There was a significant increase in the PCO2-gap value only in severe hemodilution animals. CONCLUSION: Global and regional hemodynamic stability were maintained after moderate and severe hemodilution. However, a very low hematocrit induced gastric mucosal acidosis, suggesting that gastric mucosal CO2 monitoring may be useful during major surgery or following trauma.OBJETIVO: Os efeitos da hemodiluição normovolêmica com diferentes nÃveis de hemoglobina na perfusão esplâncnica são pouco conhecidos. Testamos a hipótese que durante a hemodiluição moderada e acentuada, os parâmetros hemodinâmicos sistêmicos e regionais e as variáveis relacionadas ao metabolismo de oxigênio não refletem a adequação da perfusão da mucosa gástrica. MÉTODOS: Vinte e um cães anestesiados com fentanil e vecurônio (16±1 kg) foram randomizados como controles (CT, n=7, sem hemodiluição normovolêmica), hemodiluição normovolêmica moderada (Ht 25±3%, n=7) ou hemodiluição normovolêmica acentuada (Ht 15±3%, n=7), pela troca isovolêmica entre o sangue total e hidroxietil amido a 6%, 20 mL/min até o hematócrito pré-estabelecido para cada grupo. Os animais foram acompanhados por 120 min após a hemodiluição normovolêmica. Durante todo o experimento foram medidos o débito cardÃaco (CO, L/min), o fluxo de veia porta (PVF, mL/min), e os gradientes de CO2 veia porta-arterial e mucosa gástrica-arterial (PV-artCO2 and PCO2-gap, mmHg, respectivamente). RESULTADOS: O volume de sangue trocado foi de 33,9±3,3 mL/kg para hemodiluição normovolêmica moderada e de 61,5±5,8 mL/kg para a hemodiluição normovolêmica acentuada. A pressão arterial e os nÃveis de lactato sistêmico e regional permaneceram estáveis em todos os grupos. Houve aumentos iniciais de débito cardÃaco e de fluxo de veia porta, tanto na hemodiluição normovolêmica moderada quanto na hemodiluição normovolêmica acentuada; o consumo de oxigênio sistêmico e regional permaneceram estáveis, principalmente por conta de aumentos na taxa de extração de oxigênio. O PCO2-gap apresentou aumento significativo apenas nos animais submetidos a hemodiluição normovolêmica acentuada. CONCLUSÃO: Ocorre estabilidade hemodinâmica global e regional tanto na hemodiluição normovolêmica moderada quanto na acentuada. Entretanto, o hematócrito de 15% induziu acidose moderada de mucosa gástrica, o que pode ser relevante em procedimentos cirúrgicos de grande porte ou no trauma
Avaliação inicial dos gradientes sistêmicos e regionais da pCO2 como marcadores de hipoperfusão mesentérica
Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation
Gas tonometry for evaluation of gastrointestinal mucosal perfusion: experimental models of trauma, shock and complex surgical maneuvers - Part 1
Transanal Small Bowel Evisceration: An Unusual Presentation of Rectal Impalement
Traumatic transanal small bowel evisceration is a rare condition usually associated with suction injuries or blunt abdominal trauma. We report the first case of intestinal evisceration through the anus caused by penetrating trauma (rectal impalement). Additionally, we performed a literature review of all English language articles since 1970 concerned with traumatic transanal small bowel evisceration. Mechanisms of injury and the surgical management are discussed
Ethacrynic acid decreases expression of proinflammatory intestinal wall cytokines and ameliorates gastrointestinal stasis in murine postoperative ileus
OBJECTIVES: Several compounds characterized by an olefin linkage conjugated to a carbonyl group have anti-inflammatory properties. The diuretic ethacrynic acid (EA) is a compound of this type. Herein, we tested the hypothesis that ethacrynic acid can modulate the development of ileus after bowel manipulation. METHODS: Groups (n=9) of male C57Bl/6 mice underwent surgical manipulation of the small intestine using a pair of cotton-tipped applicators (MAN). Control animals (CONT) did not undergo any surgical intervention or receive treatment. MAN mice were pre- and post-treated with four intraperitoneal doses of phosphate buffered saline (PBS), EA1 (1mg/kg per dose), or EA10 (10mg/kg per dose). Gastrointestinal transit of non-absorbable FITC-labeled dextran was assessed by gavaging the mice with the tracer 24h after operation and assessing FD70 concentration 120 min later in the bowel contents from the stomach, 10 equally long segments of small intestine, cecum, and two equally long segments of colon. The geometric center for the tracer was calculated for each animal. Expression of interleukin-6 (IL-6) and inducible nitric oxide synthase (iNOS) transcripts in the ileal muscularis propria was assessed using semiquantitative reverse transcriptase-polymerase chain reaction. RESULTS: In control animals, the mean (±SE) geometric center for the transit marker was 9.89±0.47, whereas it was 4.59±0.59 for PBS-treated animals (p<0.05 vs CONT). The geometric center for pre- post treatment with low (1mg/kg) and high (10mg/kg) doses of ethacrynic acid were 7.23±0.97 and 5.15±0.57, respectively. Compared to PBS, treatment with ethacrynic acid (1mg/kg) significantly decreased manipulation-induced IL-6 and iNOS mRNA expression in the wall of the small bowel. CONCLUSIONS: Pre- and post-treatment with ethacrynic acid ameliorates ileus and modulates inflammation in the gut wall induced by bowel manipulation
Effects of Fluid Resuscitation on Cardiovascular Performance After Posttraumatic Pneumonectomy
Background: Several factors have been implicated in the high-mortality rate of posttraumatic pneumonectomy. In this study, we evaluated the hemodynamic and echocardiographic changes induced by pneumonectomy and fluid resuscitation after hemorrhagic shock. Methods: Fourteen dogs were bled to a target mean arterial pressure of 40 mmHg. The animals were assigned to two groups: control (no fluid resuscitation) and lactated Ringer`s (3 x shed blood volume). The left pulmonary hilum was cross clamped, and the animals were observed for 60 minutes. Systemic hemodynamics was evaluated using Swan-Ganz, arterial catheter, and ultrasonic flow probe. Systemic O(2)-derived variables were calculated. Ejection fraction was determined by two-dimensional echocardiography. Results: Fluid resuscitation improved the mean arterial pressure and systemic oxygen delivery. After pneumonectomy, no significant increase in right ventricular pressure was observed in the LR group. No signs of major ventricular dilation or changes in arterial oxygenation were observed. Conclusion: Our data suggest that pneumonectomy is not associated with early pulmonary hypertension; gentle fluid resuscitation improves cardiovascular performance and is not associated with an increase in right ventricular pressure