Evaluation of hemodynamic, metabolic, and electrolytic changes after graft reperfusion in a porcine model of intestinal transplantation.
BACKGROUND
We sought to establish an anesthetic protocol to evaluate the hemodynamic, metabolic, and electrolytic changes after graft reperfusion in pigs undergoing orthotopic intestinal transplant (ITx).


METHODS
Fifteen pigs were distributed into two groups: GI (n = 6), without immunosuppression, and GII (n = 9), immunosuppressed before surgery with tacrolimus (0.3 mg/kg). The animals were premedicated at 1 hour before surgery with IM acepromazine (0.1 mg/kg), morphine (0.4 mg/kg), ketamine (10 mg/kg), and atropine (0.044 mg/kg IM). Anesthesia induction used equal proportions of diazepam and ketamine (0.1-0.15 mL/kg/IV) and for maintenance in IV infusion of xylazine (1 mg/mL), ketamine (2 mg/mL), and guaiacol glyceryl ether 5% (50 mg/mL), diluted in 250 mL of 5% glucose solution. In addition, recipient pigs were treated with isofluorane inhalation. Heart rate (HR), systolic (SAP), mean (MAP), and diastolic (DAP) arterial pressure, pulse oximetry, respiratory frequency (f), capnography, body temperature (T), blood gas analysis (pH, Paco(2), Pao(2), base excess, BE; Hco(3)(-), Sato(2)), serum potassium (K), calcium (Ca), sodium, hematocrit (Hct), and glucose (Glu) were measured at four times; M0: after incision (basal value); M1: 10 minutes before reperfusion; and M2 and M3: 10 and 20 minutes after graft reperfusion.


RESULTS
All groups behaved in a similar pattern. There was significant hypotension after graft reperfusion in GI and GII (M2 = 56.2 +/- 6.4 and M3 = 57.2 +/- 8.3 mm Hg and M2 = 65.7 +/- 10.2 and M3 = 67.8 +/- 16.8 mm Hg, respectively), accompanied by elevated HR. The ETco(2) was elevated at M2 (42 mm Hg) and M3 (40 mm Hg). Metabolic acidosis was observed after reperfusion, with significant increase in K levels.


CONCLUSIONS
The anesthetic protocol for donors and recipients was safe to perform the procedure, allowing control of hemodynamic and metabolic changes after reperfusion without differences regarding immunosuppression.
de Oliveira Clark
R M
RM
Department of Surgery, Botucatu School of Medicine - Unesp, São Paulo State University, Botucatu - SP, Brazil.
Neto
A Bakonyi
AB
Bianchi
E H
EH
de Carvalho
L R
LR
D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D002118:Calcium / Q000097:blood; D006339:Heart Rate / Q000187:drug effects; D006400:Hematocrit; D006439:Hemodynamics; D007022:Hypotension / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000637:transplantation*; D023421:Models, Animal; D010092:Oximetry; D011188:Potassium / Q000097:blood; D015424:Reperfusion; D015427:Reperfusion Injury / Q000503:physiopathology; D012121:Respiration, Artificial; D013552:Swine; D016559:Tacrolimus / Q000627:therapeutic use
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D011188:Potassium; D002118:Calcium; D016559:Tacrolimus