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Anesth Analg 2006;102:1617-1622
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000219596.34753.72

CARDIOVASCULAR ANESTHESIA

Autoregulation of Human Jejunal Mucosal Perfusion During Cardiopulmonary Bypass

Andreas Nygren, MD, Anders Thorén, MD, PhD, Erik Houltz, MD, PhD, and Sven-Erik Ricksten, MD, PhD

Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg Sweden

Address correspondence and reprint requests to Sven-Erik Ricksten, MD, Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, 41345 Göteborg, Sweden. Address e-mail to sven-erik.ricksten{at}aniv.gu.se.

Animal studies have suggested that autoregulation of intestinal blood flow is severely impaired during cardiopulmonary bypass (CPB). We investigated the jejunal mucosal capacity to autoregulate perfusion during nonpulsatile CPB (34°C) in 10 patients undergoing elective cardiac surgery. Changes in mean arterial blood pressure (MAP) were induced by altering the CPB flow rate randomly for periods of 3 min from 2.4 L/min/m2 to either 1.8 or 3.0 L/min/m2. Jejunal mucosal perfusion (JMP) was continuously recorded by laser Doppler flowmetry. A typical pattern of flow motion (vasomotion) was recorded in all patients during CPB. Variations in CPB flow rates caused no significant changes in mean JMP, jejunal mucosal hematocrit, or red blood cell velocity within a range of MAP from 50 ± 15 to 74 ± 16 mm Hg. The vasomotion frequency and amplitude was positively correlated with CPB flow rate. IV injections of prostacyclin (10 µg, Flolan®) blunted vasomotion and increased JMP from 192 ± 53 to 277 ± 70 (P < 0.05) perfusion units despite a reduction in MAP from 59 ± 12 to 45 ± 10 mm Hg (P < 0.05). Prostacyclin-induced vasodilation resulted in loss of mucosal autoregulation (pressure-dependent perfusion). We conclude that autoregulation of intestinal mucosal perfusion is maintained during CPB in humans.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.