Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation

Autor(es)

Cruz Junior, Ruy J. ^[1] ; Garrido, Alejandra G. ^[2] ; e Silva, Mauricio Rocha

Afiliação do(s) autor(es)

^[1] Univ Pittsburgh, Liver Intestinal & Multivisceral Transplant Serv, Starzl Transplantat Inst, Med Ctr, Pittsburgh, PA 15213 - USA

^[2] Univ Sao Paulo, Sch Med, FMUSP, Dept Surg, BR-05508 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Acta Cirurgica Brasileira; v. 24, n. 2, p. 156-161, MAR-APR 2009.
• Citações Web of Science: 1

Resumo

Purpose: Multivisceral transplantation (MVTx) has been accepted as standard therapeutic modality for patients with short-bowel syndrome associated with irreversible liver failure. Even nowadays, experimental models of MVTx grounds high incidence of intraoperative or early recipient mortality. Despite the known deleterious effects of hepatosplanchnic exenteration the impact of this procedure on systemic hemodynamics and metabolism remains to be determined. Methods: Nine dogs (20.1 +/- 0.5 kg) were subjected to an en bloc resection of all abdominal organs including, stomach, duodenum, pancreas, liver, spleen, small bowel, and colon. A woven double velour vascular graft was interposed between the suprahepatic and infrahepatic vena cava. Systemic hemodynamic were evaluated through a Swan-Ganz catheter, ultrasonic flowprobes, and arterial lines. Systemic O(2)-derived variables, glucose, and lactate metabolism were analyzed throughout the experiment. Results: Complete abdominal exenteration was associated with significant reduction in cardiac output, and mean arterial pressure (57% and 14%, respectively). Two hours after reperfusion a significant reduction in arterial pH and glucose were also observed. Oxygen consumption remained unaltered during the first two hours of the experiment, with a significant increase of lactate levels (1.4 +/- 0.3 vs. 7.6 +/- 0.4, p<0.05). Three animals died before the 3 hours of reperfusion were completed. Total abdominal exenteration for MVTx in dogs is associated with early major hemodynamics, and metabolic changes. Conclusion: The deleterious hemodynamic alterations observed are probably related with the association of severe acidosis, hyperlactemia, hypoglycemia, and reduction of total circulating blood volume. Close hemodynamic and metabolic monitoring should be provided during experimental MVTx in order to promote an increase in successful rates of this complex and challenging procedure. (AU)

• Processo FAPESP: 06/02555-6 - Efeitos hemodinâmicos, metabólicos e citoprotetores do anticorpo monoclonal anti-TNF-alfa no processo de isquemia e reperfusão intestinal
• Beneficiário: Ruy Jorge Cruz Junior
• Modalidade de apoio: Auxílio à Pesquisa - Regular