The effects of intravenous nitroglycerine and norepinephrine on gastric microvascular perfusion in an experimental model of gastric tube reconstruction

Van Bommel, Jasper; De Jonge, Jeroen; Buise, Marc P.; Specht, Patricia; Van Genderen, Michel; Gommers, Diederik

doi:10.1016/j.surg.2009.12.011

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Volume 148, Issue 1 , Pages 71-77, July 2010

The effects of intravenous nitroglycerine and norepinephrine on gastric microvascular perfusion in an experimental model of gastric tube reconstruction

Jasper Van Bommel, MD, PhD
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
- Reprint requests: Jasper Van Bommel, MD, PhD, Department of Intensive Care H-602, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Jeroen De Jonge, MD, PhD
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
Marc P. Buise, MD
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Anesthesiology, ICU, and Pain Therapy, Catharina Hospital, Eindhoven, The Netherlands
Patricia Specht
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
Michel Van Genderen
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
Diederik Gommers, MD, PhD
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands

Accepted 15 December 2009. published online 11 February 2010.

Background

Esophagectomy with gastric tube reconstruction is the surgical treatment for cancer of the esophagus. Perfusion of the anastomotic site of the tube depends exclusively on microcirculation, making it susceptible to hypoperfusion. It is unknown whether vasodilatation is superior to increased perfusion pressure to improve gastric tissue perfusion of the anastomosis.

Methods

We performed a gastric tube reconstruction in 12 pigs, mean body weight 32 ± 2 kg. Besides systemic hemodynamic parameters, gastric microvascular blood flow (MBF) was assessed with laser Doppler flowmetry and gastric microvascular HbO₂ saturation (μHbSO₂) and Hb concentration (μHbcon) with spectrophotometry. Animals were randomized over 2 groups: with and without intravenous nitroglycerin (NTG). In both groups, mean arterial pressure (MAP) was increased from 50 to 110 mmHg with infusion of norepinephrine; in the NTG group, central venous pressure was maintained below 10 mmHg throughout the experiment with NTG.

Results

Except for central venous and pulmonary capillary wedge pressures, all hemodynamic parameters were similar in both groups. Especially in corpus and fundus, MBF decreased following surgery. However, overall MBF was significantly higher in the NTG group. Increasing MAP had no effect on fundus MBF. Gastric μHbSO₂ and μHbcon were not different between groups and did not change at higher MAP levels.

Conclusion

In our experimental model of gastric tube reconstruction, tissue perfusion is severely compromised; this effect is aggravated by systemic hypotension independent from cardiac output. Impaired venous outflow might contribute to this effect and can be counteracted with infusion of nitroglycerine.