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CARDIOVASCULAR ANESTHESIA

Jejunal Mucosal Perfusion Is Well Maintained During Mild Hypothermic Cardiopulmonary Bypass in Humans

Anders Thorén, MD^*, Mikael Elam, MD, PhD, and Sven-Erik Ricksten, MD, PhD^*

Departments of *Cardiothoracic Anesthesia and Intensive Care and Clinical Neurophysiology, Sahlgrenska University Hospital, Göteborg, Sweden

Address correspondence and reprint requests to Sven-Erik Ricksten, MD, PhD, Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. Address e-mail to sven-erik.ricksten{at}aniv.gu.se

In the present study, the effects of mild hypothermic (34°C) cardiopulmonary bypass (CPB) on jejunal mucosal perfusion (JMP), gastric tonometry, splanchnic lactate, and oxygen extraction were studied in low-risk cardiac surgical patients (n = 10), anesthetized and managed according to clinical routine. JMP was assessed by endoluminal laser Doppler flowmetry. Patients were studied during seven 10-min measurement periods before, during, and 1 h after the end of CPB. Splanchnic oxygen extraction increased during hypothermia and particularly during rewarming and warm CPB. JMP increased during hypothermia (26%), rewarming (31%), and warm CPB (38%) and was higher 1 h after CPB (42%), compared with pre-CPB control. The gastric-arterial PCO₂ difference was slightly increased (range 0.04–2.26 kPa) during rewarming and warm CPB as well as 1 h after CPB, indicating a mismatch between gastric mucosal oxygen delivery and demand. None of the patients produced lactate during CPB. We conclude that jejunal mucosal perfusion appears well preserved during CPB and moderate (34°C) hypothermia; this finding is in contrast to previous studies showing gastric mucosal hypoperfusion during CPB.

Implications: Jejunal mucosal perfusion increases during mild hypothermic cardiopulmonary bypass (CPB). Intestinal laser Doppler flowmetry, gastric tonometry, and measurements of splanchnic lactate extraction could not reveal a local or global splanchnic ischemia during or after CPB. A mismatch between splanchnic oxygen delivery and demand was seen, particularly during rewarming and warm CPB.

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