Postoperative sublingual microcirculatory derangement following esophagectomy is prevented with dobutamine.
BACKGROUND
Esophagectomy with gastric tube reconstruction is characterized by high postoperative morbidity rates. Recently it was shown that decreased sublingual microvascular blood flow (MBF) preoperatively was associated with increased rate of complications after abdominal surgery. Similar observations in severely septic patients could be treated with dobutamine, independent of cardiac output. Based on these considerations we hypothesized that sublingual MBF derangements are more likely to be found in patients undergoing high risk surgery such as esophagectomy, and if present, might be prevented with administration of low dose dobutamine.


METHODS
In this single-centre, prospective, double-blinded study, we randomized 20 patients admitted to the Intensive Care Unit following esophagectomy with gastric tube reconstruction into two groups. The intervention group (D) received a small dose of dobutamine (2.5 μg/kg/min) directly postoperative until two days postoperatively, whereas the placebo group (P) received a similar volume of saline. A subset of patients undergoing pancreaticoduodenectomy surgery was included as control group (C) for comparison with the study group. Sublingual MBF was determined one day prior to surgery until two days postoperatively.


RESULTS
At the first postoperative day, patients in the esophagectomy/placebo group (P), showed a significant lower microvascular flow index, perfused vessel density and proportion of perfused vessels compared to baseline (p < 0.001) and the pancreaticoduodenectomy group (C) (p < 0.001). Administration of dobutamine significantly prevented the overall decrease in microvascular blood flow the first postoperative day.


CONCLUSIONS
Postoperative sublingual MBF is markedly impaired in esophagectomy patients compared to patients who underwent a pancreaticoduodenectomy and could be prevented by early administration of a small dose dobutamine.
Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands. mvgenderen@gmail.com
Michel
M
van Genderen
Diederik
D
Gommers
Eva
E
Klijn
Alex
A
Lima
Jan
J
Bakker
Jasper
J
van Bommel
D000368:Aged; D004280:Dobutamine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D009060:Mouth Floor / Q000098:blood supply*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods
D004280:Dobutamine