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Sublingual microcirculation is impaired on the first day postoperatively in patients undergoing gastric tube reconstruction

Introduction

Complications of oesophagectomy with gastric tube reconstruction include leakage and stenosis. This can be explained by compromised local perfusion, although it is unclear to which extent local and systemic factors contribute to this process. The aim of this study was to observe the microvascular blood flow in an unaffected, distant tissue during the perioperative period.

Methods

Twelve patients were included. Anesthesia consisted of thoracic epidural analgesia, restrictive peroperative fluid therapy (net peroperative fluid balance below 4 l) and early extubation. In the ICU, fluid infusion was adjusted in order to maintain hourly urine production of 0.5 ml/kg. The mean arterial pressure was maintained at or above 60 mmHg with administration of nor-adrenalin if necessary. Microcirculation was visualized in the sublingual tissue with the MicroScan, a sidestream dark field imager. Data were collected at five time points: immediately after induction, after gastric tube reconstruction, directly postoperative, and days 1 and 2 postoperatively. Video data collected with the MicroScan were analysed according to semiquantitative analysis described by Boerma and colleagues [1]. We divided the vessels into three categories: small (5–10 μm), medium (10–15 μm) and large (>15 μm). By dividing the images into four quadrants and categorizing the flow per vessel-size per quadrant, we calculated the microvascular flow index (MFI)

Results

See Figure 1.

Figure 1
figure1

Sublingual microvascular perfusion.

Conclusion

The sublingual microcirculation is decreased on the first day postoperatively in patients undergoing gastric tube reconstruction.

References

  1. 1.

    Boerma EC, Mathura KR, van der Voort PH, et al.: Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care 2005, 9: R601-R606. 10.1186/cc3809

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Van Bommel, J., Tilanus, H., Bakker, J. et al. Sublingual microcirculation is impaired on the first day postoperatively in patients undergoing gastric tube reconstruction. Crit Care 11, P265 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5425

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Keywords

  • Fluid Balance
  • Epidural Analgesia
  • Dark Field
  • Fluid Infusion
  • Dark Field Imager