Protection of cerebral microcirculation, mitochondrial function, and electrocortical activity by small-volume resuscitation with terlipressin in a rat model of haemorrhagic shock

Autor(es)

Ida, K. K. ^{[1, 2]} ; Chisholm, K. I. ^[1] ; Malbouisson, L. M. S. ^[2] ; Papkovsky, D. B. ^[3] ; Dyson, A. ^[4] ; Singer, M. ^[4] ; Duchen, M. R. ^[5] ; Smith, K. J. ^[1]

Afiliação do(s) autor(es)

^[1] UCL, Inst Neurol, Queen Sq, London - England

^[2] Univ Sao Paulo, Sch Med, Postgrad Program Anaesthesiol, Lab Med Invest 8, Sao Paulo - Brazil

^[3] Univ Coll Cork, Sch Biochem & Cell Biol, Cork - Ireland

^[4] UCL, Bloomsbury Inst Intens Care Med, London - England

^[5] UCL, Cell & Dev Biol, London - England

• Tipo de documento: Artigo Científico
• Fonte: BRITISH JOURNAL OF ANAESTHESIA; v. 120, n. 6, p. 1245-1254, JUN 2018.
• Citações Web of Science: 2

Resumo

Background: During early treatment of haemorrhagic shock, cerebral perfusion pressure can be restored by small-volume resuscitation with vasopressors. Whether this therapy is improved with additional fluid remains unknown. We assessed the value of terlipressin and lactated Ringer's solution (LR) on early recovery of microcirculation, tissue oxygenation, and mitochondrial and electrophysiological function in the rat cerebral cortex. Methods: Animals treated with LR replacing three times (3LR) the volume bled (n = 26), terlipressin (n = 27), terlipressin plus 1LR (n = 26), 2LR (n = 16), or 3LR (n = 15) were compared with untreated (n = 36) and sham-operated rats (n = 17). In vivo confocal microscopy was used to assess cortical capillary perfusion, changes in tissue oxygen concentration, and mitochondrial membrane potential and redox state. Electrophysiological function was assessed by cortical somatosensory evoked potentials, spinal cord dorsum potential, and peripheral electromyography. Results: Compared with sham treatment, haemorrhagic shock reduced the mean (SD) area of perfused vessels {[}82% (SD 10%) vs 38% (12%); P<0.001] and impaired oxygen concentration, mitochondrial redox state {[}99% (4%) vs 59% (15%) of baseline; P<0.001], and somatosensory evoked potentials {[}97%(13%) vs 27%(19%) of baseline]. Administration of terlipressin plus 1LR or 2LR was able to recover these measures, but terlipressin plus 3LR or 3LR alone were not as effective. Spinal cord dorsum potential was preserved in all groups, but no therapy protected electromyographic function. Conclusions: Resuscitation from haemorrhagic shock using terlipressin with small-volume LR was superior to high-volume LR, with regard to cerebral microcirculation, and mitochondrial and electrophysiological functions. (AU)

• Processo FAPESP: 11/14386-2 - Comparação dos efeitos da ressuscitação com Ringer lactato, solução salina hipertônica e terlipressina sobre a perfusão e oxigenação cerebral em modelo experimental de choque hemorrágico
• Beneficiário: Keila Kazue Ida
• Modalidade de apoio: Bolsas no Brasil - Doutorado