[How should we treat intestinal ischemia?--II: Effects of pentoxifylline, glucagon and prostaglandin E1].
It is important to repair or ameliorate the intestinal ischemia in critically ill patients. Recent study of our suggests the superiority of dobutamine, but not dopamine, in improving the intestinal oxygenation. In this study we examined the effects of pentoxifylline (PF), glucagon (GL) and prostaglandin E1 (PGE1) during reduced blood flow of the superior mesenteric artery (SMA) in 20 anesthetized dogs. As an index of the intestinal oxygenation, tonometrically measured intestinal intramural pH (pHi) was used. A tonometer was inserted into the midjejunum through enterotomy. The SMA blood flow was measured by a transit-time flow meter. A vascular screw clamp for blood flow reduction was placed around the origin of the SMA, proximal to the flow probe. The SMA blood flow was adjusted to 70% of baseline for three hours. After two hours of decreased blood flow, pHi dropped significantly from baseline. Then, either PF (20 mg.kg-1.min-1 over 10 min, followed by 0.1 mg.kg-1.min-1), GL (1 microgram.kg-1.min-1) or PGE1 (0.05 and 0.5 microgram.kg-1.min-1) was infused intravenously for one hour. With infusions of GL and large dose of PGE1, pHi tended to decrease further, although GL increased the cardiac output. Small dose of PGE1 had no significant effect on pHi. PF treatment showed beneficial effects not only on the cardiac output and the SMA blood flow, but also on pHi. We conclude that PF therapy may restore the intestinal microvascular blood flow. Further study of the effects of PF on tissue oxygenation and blood rheology is warranted.
Sakio
H
H
Second Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi.
Tanaka
Y
Y
Ueno
K
K
Oishi
S
S
Ohtsu
S
S
Okuda
C
C
D000527:Alprostadil / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D004285:Dogs; D005934:Glucagon / Q000494:pharmacology / Q000627:therapeutic use*; D006863:Hydrogen-Ion Concentration; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000188:drug therapy*; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D010101:Oxygen Consumption / Q000187:drug effects; D010431:Pentoxifylline / Q000494:pharmacology / Q000627:therapeutic use*; D012039:Regional Blood Flow / Q000187:drug effects
D005934:Glucagon; D000527:Alprostadil; D010431:Pentoxifylline