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Anesth Analg 2006;103:948-954
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000237125.42376.b5

CRITICAL CARE AND TRAUMA

Cerebral Metabolism Assessed with Microdialysis in Uncontrolled Hemorrhagic Shock After Penetrating Liver Trauma

Patrick Meybohm, MD, Erol Cavus, MD, Berthold Bein, MD, Markus Steinfath, MD, Philipp-Alexander Brand, MD, Jens Scholz, MD, and Volker Dörges, MD

From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.

Address correspondence and reprint requests to Dr. med. Patrick Meybohm, University Hospital Schleswig-Holstein, Campus Kiel, Department of Anaesthesiology and Intensive Care Medicine, Schwanenweg 21, D-24105 Kiel, Germany. Address e-mail to meybohm{at}anaesthesie.uni-kiel.de.

In a porcine model of uncontrolled hemorrhagic shock, we evaluated the effects of fluid resuscitation versus arginine vasopressin (AVP) combined with hypertonic-hyperoncotic hydroxyethyl starch solution (HHS) on cerebral perfusion pressure (CPP) and on cerebral metabolism using intracerebral microdialysis. Sixteen anesthetized pigs were subjected to uncontrolled liver bleeding until hemodynamic decompensation, followed by resuscitation using either fluid (n = 8) or AVP/HHS (n = 8). Thirty minutes after drug administration, bleeding was controlled by manual compression, and colloid and crystalloid solutions were administered in both groups. All surviving animals were observed for one hour. After hemodynamic decompensation, fluid resuscitation resulted in a smaller increase of CPP than did AVP/HHS (mean ± sem; 24 ± 5 vs 45 ± 7 mm Hg; P < 0.01). Mean (± sem) cerebral venous partial pressure of oxygen was significantly decreased (P < 0.01) 5 min after fluid compared with 5 min after AVP/HHS administration (36 ± 3 vs 64 ± 4 torr). Cerebral metabolism was comparable in both groups. In conclusion, AVP/HHS proved to be superior to fluid in the initial phase of therapy with respect to CPP and cerebral oxygenation, but was comparable to fluid regarding cerebral metabolism and secondary cell damage in surviving animals.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of 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.