title: Use of rapid sampling microdialysis for intraoperative monitoring of bowel ischemia.
abstract: OBJECTIVE
  Intestinal ischemia is a major cause of anastomotic leak and death and remains a clinical challenge as the physician relies on several nonspecific signs, biologic markers, and radiologic studies to make the diagnosis. This study used rapid sampling online microdialysis to evaluate the biochemical changes occurring in a segment of human bowel during and after resection, and assessed for the feasibility and reproducibility of this technique in monitoring intestinal ischemia.
  
  
  METHODS
  A custom made, rapid sampling online microdialysis analyzer was used to monitor the changes in the bowel wall of specimens being resected intraoperatively. Two patients were recruited for the pilot study to optimize the analyzer and seven patients undergoing colonic resections were recruited for the data collection and analysis.
  
  
  RESULTS
  The concentration of glucose in the extracellular bowel wall fluid decreased transiently after division of individual feeding arteries followed by a rebound increase in the concentration back to baseline concentrations. After completion of resection, glucose concentrations continued to decrease while lactate concentrations increased constantly.
  
  
  CONCLUSIONS
  Rapid sampling microdialysis was feasible in the clinical environment. These results suggest that tissue responds to ischemic insult by mobilizing glucose stores which later decrease again, whereas lactate concentrations constantly increased.
authors.affiliation: Department of BioSurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Deeba
authors.forename: E P
authors.initials: EP
authors.lastname: Corcoles
authors.forename: G B
authors.initials: GB
authors.lastname: Hanna
authors.forename: B G
authors.initials: BG
authors.lastname: Hanna
authors.forename: P
authors.initials: P
authors.lastname: Pareskevas
authors.forename: O
authors.initials: O
authors.lastname: Aziz
authors.forename: M G
authors.initials: MG
authors.lastname: Boutelle
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D003082:Colectomy; D003106:Colon / Q000098:blood supply* / Q000378:metabolism / Q000601:surgery; D005240:Feasibility Studies; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D007511:Ischemia / Q000175:diagnosis / Q000517:prevention & control*; D019344:Lactic Acid / Q000378:metabolism; D017551:Microdialysis; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D009862:Online Systems; D015203:Reproducibility of Results
chemical_list: D019344:Lactic Acid; D005947:Glucose