Advertisement

Journal of Gastrointestinal Surgery

, Volume 12, Issue 9, pp 1497–1501 | Cite as

The Effects of Vasopressors on Perfusion of Gastric Graft after Esophagectomy. An Experimental Study

  • Dimitrios Theodorou
  • Panagiotis G. Drimousis
  • Andreas LarentzakisEmail author
  • Apostolos Papalois
  • Konstantinos G. Toutouzas
  • Stylianos Katsaragakis
original article

Abstract

Aims

To evaluate the impact of the perioperative administration of norepinephrine on the perfusion of the esophageal graft.

Methods

This is an experimental study. Six swine underwent transhiatal esophagectomy; the stomach was used to replace the resected esophagus. We provoked hemorrhagic shock to the animals and then we administered noradrenaline to restore the blood pressure. We monitored the graft perfusion perioperatively using the technique of microdialysis.

Results

In all animals, the graft experienced severe hypoperfusion after the administration of noradrenaline that was statistically significant.

Conclusions

Our data support the hypothesis that norepinephrine should be used with extreme caution in the perioperative setting after esophagectomy. Further studies, however, will be required to evaluate the clinical significance of this finding.

Keywords

Esophagectomy Norepinephrine Gastric graft perfusion Experimental study 

References

  1. 1.
    Atkins ZB, Ashish SS, Hutcheson KA et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004;78:1170–1176. doi: 10.1016/j.athoracsur.2004.02.034.PubMedCrossRefGoogle Scholar
  2. 2.
    Oschner A, DeBakey M. Surgical aspects of carcinoma of the esophagus. J Thorac Surg 1941;10:401–445.Google Scholar
  3. 3.
    Bartels H, Stein HJ, Siewert JR. Preoperative risk analysis and postoperative mortality of oesophagectomy for respectable oesophageal cancer. Br J Surg 1998;85:840–844. doi: 10.1046/j.1365-2168.1998.00663.x.PubMedCrossRefGoogle Scholar
  4. 4.
    Ferguson MK, Martin TR, Reeder LB et al. Mortality after esophagectomy: risk factor analysis. World J Surg 1997;21:599–604. doi: 10.1007/s002689900279.PubMedCrossRefGoogle Scholar
  5. 5.
    Law S, Wong KH, Kwok KF et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 2004;240:791–800. doi: 10.1097/01.sla.0000143123.24556.1c.PubMedCrossRefGoogle Scholar
  6. 6.
    Dimick JB, Pronovost PJ, Cowan JA et al. Complications and costs after high-risk surgery: where should we focus quality improvement initiatives. J Am Coll Surg 2003;196:671–678. doi: 10.1016/S1072-7515(03)00122-4.PubMedCrossRefGoogle Scholar
  7. 7.
    Karl RC, Schreiber R, Boulware D et al. Factors affecting morbidity, mortality and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 2000;231:635–643. doi: 10.1097/00000658-200005000-00003.PubMedCrossRefGoogle Scholar
  8. 8.
    Jansson K, Ungerstedt J, Jonsson T et al. Human intraperitoneal microdialysis: increased lactate/pyruvate ratio suggests early visceral ischemia. A pilot study. Scand J Gastroenterol 2003;38(9):1007–1011. doi: 10.1080/00365520310004065.PubMedCrossRefGoogle Scholar
  9. 9.
    Sommer T, Larsen JF. Validation of intramural intestinal microdialysis as a detector of intestinal ischaemia. Scand J Gastroenterol. 2004;39(5):493–499. doi: 10.1080/00365520310008791.PubMedCrossRefGoogle Scholar
  10. 10.
    Matthiessen P, Strand I, Jansson K, Törnquist C, Andersson M, Rutegård J et al. Is early detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer? Dis Colon Rectum. 2007;50(11):1918–1927. doi: 10.1007/s10350-007-9023-4.PubMedCrossRefGoogle Scholar
  11. 11.
    Jansson K, Strand I, Redler B, Magnuson A, Ungerstedt U, Norgren L. Results of intraperitoneal microdialysis depend on the location of the catheter. Scand J Clin Lab Invest 2004;64(1):63–70. doi: 10.1080/00365510410004100.PubMedCrossRefGoogle Scholar
  12. 12.
    Ramirez JM, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume center. Eur J Cardio-thorac Surg 2005;27:3–7. doi: 10.1016/j.ejcts.2004.09.018.CrossRefGoogle Scholar
  13. 13.
    Bardini R, Asolati M, Ruol A et al. Anastomosis. World J Surg 1994;18:373–378. doi: 10.1007/BF00316817.PubMedCrossRefGoogle Scholar
  14. 14.
    Blom D, Peters J, DeMeester TR. Controversies in the current therapy of carcinoma of the esophagus. J Am Coll Surg 2002;195(2):241–250. doi: 10.1016/S1072-7515(02)01221-8.PubMedCrossRefGoogle Scholar
  15. 15.
    Pickleman J, Watson W, Cunningham J et al. The failed gastrointestinal anastomosis:an inevitable catastrophe? J Am Coll Surg. 1999;188:473–482. doi: 10.1016/S1072-7515(99)00028-9.PubMedCrossRefGoogle Scholar
  16. 16.
    Miller JD, Jain MK, de Gara CJ et al. Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 1997;65:20–21. doi: 10.1002/(SICI)1096-098(199705)65:1<20::AID-JSO4>3.0.CO;2-Q.PubMedCrossRefGoogle Scholar
  17. 17.
    Swanson SJ, Batirel HF, Bueno R et al. Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 2001;72:1918–1925. doi: 10.1016/S0003-4975(01)03203-9.PubMedCrossRefGoogle Scholar
  18. 18.
    Kolh P, Honore P, Degauque C et al. Early stage results after oesophageal resection for malignancy-colon interposition vs gastric pull-up. Eur J Cardiothorac Surg 2000;18:293–300. doi: 10.1016/S1010-7940(00)00524-8.PubMedCrossRefGoogle Scholar
  19. 19.
    Norgen L, Jansson K. Intraperitoneal and intraluminal microdialysis in the detection of experimental regional intestinal ischaemia. Br J Surg 2004;91:855–861. doi: 10.1002/bjs.4586.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Dimitrios Theodorou
    • 1
  • Panagiotis G. Drimousis
    • 1
  • Andreas Larentzakis
    • 1
    • 3
    Email author
  • Apostolos Papalois
    • 2
  • Konstantinos G. Toutouzas
    • 1
  • Stylianos Katsaragakis
    • 1
  1. 1.1st Department of Propaedeutic SurgeryAthens Medical School, University of Athens, “Hippocration” General Hospital of AthensAthensGreece
  2. 2.Department of experimental surgeryELPEN LaboratoriesAthensGreece
  3. 3.EgaleoGreece

Personalised recommendations