The effect of a mesenteric traction syndrome on internal carotid artery blood flow

N. Olesen, A. H. Egesborg, H. Frederiksen, L. Svendsen, N. Secher
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Abstract

Purpose During abdominal surgery, manipulation of internal organs may induce a “mesenteric traction syndrome” (MTS) including a triad of flushing, hypotension, and tachycardia that lasts for approximately 30 min. We evaluated whether MTS affects internal carotid artery blood flow. Methods This prospective cohort study included 27 patients aged 65 ± 11 years (mean ± SD) undergoing stomach resection (n = 12), esophageal resection (n = 14), or gastro-entero anastomosis (n = 1) during propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound determined internal carotid artery blood flow, laser Doppler flowmetry assessed forehead skin blood flow, and near-infrared spectroscopy determined cerebral oxygenation. Development of MTS was defined by flushing within 60 min after incision. Results Seven patients developed MTS 22 [20–26; median (IQR)] min after incision and at that time the change in heart rate (to 87 ± 13 vs. 70 ± 11 bpm; P = 0.0007) and skin blood flow (to 214 (134–269) vs. 84 (59-112 PU; P = 0.0044) was higher in the patients who developed MTS as compared to those who did not, while mean arterial pressure (63 ± 13 vs. 64 ± 14 mmHg; P = 0.1433), cerebral oxygenation (69 ± 9% vs. 63 ± 10%; P = 0.2485), and internal carotid artery flow (225 ± 53 vs. 203 ± 69 ml/min; P = 0.9529) were similar. Conclusion Hemodynamic perturbations are observed in some patients in response to manipulation of the viscera, but the development of MTS appears not to influence internal carotid artery flow. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02951273?term=NCT02951273&rank=1, identifier: NCT02951273.
肠系膜牵引综合征对颈内动脉血流的影响
在腹部手术中,对内脏器官的操作可能引起“肠系膜牵引综合征”(MTS),包括持续约30分钟的潮红、低血压和心动过速三重症状。我们评估了MTS是否影响颈内动脉血流。方法前瞻性队列研究纳入27例患者,年龄65±11岁(mean±SD),在异丙酚-瑞芬太尼胸廓硬膜外麻醉下行胃切除术(n = 12)、食管切除术(n = 14)或胃肠吻合(n = 1)。双工超声检测颈内动脉血流,激光多普勒血流仪检测前额皮肤血流,近红外光谱检测脑氧合。切口后60分钟内冲洗确定MTS的发展情况。结果7例患者发生MTS 22 [20-26];切口后中位数(IQR) min,此时心率变化(87±13 vs 70±11 bpm;P = 0.0007)和皮肤血流量(分别为214(134-269)和84 (59-112);P = 0.0044),而平均动脉压(63±13比64±14 mmHg;P = 0.1433),脑氧合(69±9% vs. 63±10%;P = 0.2485),颈内动脉血流(225±53 vs. 203±69 ml/min;P = 0.9529)相似。结论部分患者对脏器操作有血流动力学扰动,但MTS的发展似乎不影响颈内动脉血流。临床试验注册https://clinicaltrials.gov/ct2/show/NCT02951273?term=NCT02951273&rank=1,标识符:NCT02951273。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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