Systemic and regional effects of supraceliac aortic occlusion during experimental hepatic vascular exclusion.
BACKGROUND
Supraceliac aortic occlusion (AO) has been recommended to avoid hypotension during hepatic vascular exclusion (HVE). We hypothesized that AO may negatively affect splanchnic perfusion during HVE.


METHODS
Twenty-six dogs (16 +/- 0.3 kg) were randomly assigned to HVE (n = 13) or HVE+AO (n = 13), during 30 minutes followed by a 60-minute reperfusion period. Cardiac output (CO), mean arterial pressure (MAP), superior mesenteric artery blood flow (SMABF, ultrasonic flowprobe), gastric mucosal PCO(2) (gas tonometry) and PCO(2)-gap were evaluated.


RESULTS
HVE alone induced decreases in MAP from 115 +/- 5.1 to 26 +/- 1 mm Hg, in CO from 2.0 +/- 0.1 to 0.4 +/- 0.1 L/min and SMABF from 398 +/- 42 to 16 +/- 7.6 mL/min, while PCO(2) gap increased from 4 +/- 3.7 to 52 +/- 5.4 mm Hg. Supraceliac aortic occlusion only avoided severe hypotension. During reperfusion MAP, CO, and SMABF were partially restored, while PCO(2) gap showed no improvements in either group.


CONCLUSIONS
HVE promotes major systemic and splanchnic perfusional derangement. Concomitant AO may avoid HVE-induced hypotension without producing further deleterious effects.
Cruz
Ruy J
RJ
Division of Applied Physiology, Heart Institute-InCor, and Department of Surgery, University of São Paulo Medical School, Rua Marivaldo Fernandes, 140, São Paulo, SP 04792-060, Brazil. expcruzjr@incor.usp.br
de Figueiredo
Luiz F Poli
LF
Braz
Jose L M
JL
Diniz
Edna A
EA
Rocha e Silva
Mauricio
M
D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D001784:Blood Gas Analysis; D003250:Constriction; D004064:Digestive System / Q000098:blood supply*; D004285:Dogs; D006439:Hemodynamics / Q000502:physiology*; D006498:Hepatectomy / Q000009:adverse effects; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D007511:Ischemia / Q000209:etiology*; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D023421:Models, Animal; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control; D013152:Splanchnic Circulation / Q000502:physiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*