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Suzuki M, Shibata J, Mochizuki T, Bito H. Contribution of prophylactic administration of flurbiprofen for mesenteric traction syndrome to postoperative leakage or bleeding in gastrointestinal surgery: a retrospective observational study. Langenbecks Arch Surg 2023; 408:337. [PMID: 37632575 DOI: 10.1007/s00423-023-03077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Mesenteric traction syndrome (MTS) sometimes occurs during abdominal surgery. Prophylactic administration of flurbiprofen, a non-steroidal anti-inflammatory drug, prevents the development of MTS. However, administration of non-steroidal anti-inflammatory drugs for postoperative pain increases the incidence of postoperative bleeding. Our aim was to examine the effect of prophylactic flurbiprofen administration on postoperative leakage or bleeding after gastrointestinal surgery. METHODS A retrospective observational study on patients who underwent open or laparoscopic abdominal surgery was conducted. Perioperative, anesthesia and medical records were reviewed. Patients who did (Flurbio-Group) or did not receive (Control-Group) prophylactic flurbiprofen administration were compared. Then, the Flurbio-Group and Control-Group were each divided into two groups according to whether the patients did or did not develop MTS (Flurbio-MTS-Group and Flurbio-no-MTS-Group, respectively, Control-MTS-Group and Control-no-MTS-Group, respectively). RESULTS This study included 188 patients (Flurbio-MTS-Group, 1 patient; Flurbio-no-MTS-Group, 31 patients; Control-MTS-Group, 59 patients; Control-no-MTS-Group, 97 patients). Seventeen patients developed postoperative leakage or bleeding. Eleven Flurbio-MTS-Group patients (18.6%), 4 Flurbio-no-MTS-Group patients (12.9%, 4/31), and only 2 Control-no-MTS-Group patients (2%, 2/97) developed postoperative leakage or bleeding. Multivariate logistic regression analysis demonstrated that there was a qualitative interaction effect between prophylactic administration of flurbiprofen and the development of MTS on postoperative leakage or bleeding. CONCLUSION Prophylactic flurbiprofen administration increased the risk of postoperative leakage or bleeding among patients who did not develop MTS.
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Affiliation(s)
- Manzo Suzuki
- Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, 1-396 Kosugi-Cho Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan.
- Department of Anesthesiology and Resuscitology (Okazaki Medical Center), Fujita Health University School of Medicine, 1 Gotanda Harizaki-Cho, Okazaki Aichi, 444-0827, Japan.
| | - Junpei Shibata
- Department of Anesthesiology and Resuscitology (Okazaki Medical Center), Fujita Health University School of Medicine, 1 Gotanda Harizaki-Cho, Okazaki Aichi, 444-0827, Japan
| | - Toshiaki Mochizuki
- Department of Anesthesiology and Resuscitology (Okazaki Medical Center), Fujita Health University School of Medicine, 1 Gotanda Harizaki-Cho, Okazaki Aichi, 444-0827, Japan
| | - Hiroyasu Bito
- Department of Anesthesiology and Resuscitology (Okazaki Medical Center), Fujita Health University School of Medicine, 1 Gotanda Harizaki-Cho, Okazaki Aichi, 444-0827, Japan
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Olsen AA, Burgdorf S, Bigler DR, Siemsen M, Aasvang EK, Goetze JP, Svendsen MBS, Svendsen LB, Achiam MP. Laser Speckle Contrast Imaging-based diagnosis of severe mesenteric traction syndrome: Hemodynamics and prostacyclin - A prospective cohort study. Microvasc Res 2023; 147:104505. [PMID: 36801270 DOI: 10.1016/j.mvr.2023.104505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
BRIEF ABSTRACT Today, the diagnosis and grading of mesenteric traction syndrome relies on a subjective assessment of facial flushing. However, this method has several limitations. In this study, Laser Speckle Contrast Imaging and a predefined cut-off value are assessed and validated for the objective identification of severe mesenteric traction syndrome. BACKGROUND Severe mesenteric traction syndrome (MTS) is associated with increased postoperative morbidity. The diagnosis is based on an assessment of the developed facial flushing. Today this is performed subjectively, as no objective method exists. One possible objective method is Laser Speckle Contrast Imaging (LSCI), which has been used to show significantly higher facial skin blood flow in patients developing severe MTS. Using these data, a cut-off value has been identified. This study aimed to validate our predefined LSCI cut-off value for identifying severe MTS. METHODS A prospective cohort study was performed on patients planned for open esophagectomy or pancreatic surgery from March 2021 to April 2022. All patients underwent continuous measurement of forehead skin blood flow using LSCI during the first hour of surgery. Using the predefined cut-off value, the severity of MTS was graded. In addition, blood samples for prostacyclin (PGI2) analysis and hemodynamics were collected at predefined time points to validate the cut-off value. MAIN RESULTS Sixty patients were included in the study. Using our predefined LSCI cut-off value, 21 (35 %) patients were identified as developing severe MTS. These patients were found to have higher concentrations of 6-Keto-PGFaα (p = 0.002), lower SVR (p < 0.001), lower MAP (p = 0.004), and higher CO (p < 0.001) 15 min into surgery, as compared with patients not developing severe MTS. CONCLUSION This study validated our LSCI cut-off value for the objective identification of severe MTS patients as this group developed increased concentrations of PGI2 and more pronounced hemodynamic alterations compared with patients not developing severe MTS.
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Affiliation(s)
- August Adelsten Olsen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Stefan Burgdorf
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dennis Richard Bigler
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mette Siemsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Eske Kvanner Aasvang
- Department of Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Lars Bo Svendsen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Michael Patrick Achiam
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
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Olsen AA, Bazancir LA, Dahl S, Fukumori D, Shiwaku H, Svendsen LB, Achiam MP. Mesenteric traction syndrome - Incidence, impact, and treatment: A systematic scoping review of the literature. Anaesth Crit Care Pain Med 2023; 42:101162. [PMID: 36162787 DOI: 10.1016/j.accpm.2022.101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/14/2022] [Accepted: 09/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mesenteric traction syndrome (MTS) is commonly seen during major abdominal surgery and is characterised by facial flushing, hypotension, and tachycardia 15 min into surgery. MTS also impacts the postoperative course, as severe MTS has been associated with increased postoperative morbidity. However, despite MTS being common and severe MTS causing increased postoperative morbidity, the gaps in the literature are not clearly defined. We aimed to examine the diagnostic criteria, incidence, intraoperative and postoperative impact, and potential preventative measures of MTS while highlighting potential gaps in the literature. METHODS We followed the Prisma guidelines and performed a systematic literature search. We included only human studies examining MTS. All hits were screened for title and abstract, followed by a full-text review by at least two authors for determining eligibility for inclusion. Data were extracted and risk of bias was assessed by two independent reviewers. RESULTS A total of 37 studies, comprising 1102 patients were included in the review. The combined incidence of MTS during open abdominal surgery was found to be 76%, with 35% developing severe MTS. It was found that the development of MTS was associated with marked haemodynamic changes. It was also found that several different subjective diagnostic criteria exist and that severe MTS was associated with increased postoperative morbidity. Furthermore, several preventative measures for protecting against MTS have been examined, but only on the incidence of MTS and not on the postoperative course. CONCLUSION MTS occurs in 76% of patients undergoing major abdominal surgery and is associated with deleterious haemodynamic effects, which are more pronounced in patients developing severe MTS. Severe MTS is also associated with a worse postoperative outcome. However, gaps are still present in the current literature on MTS.
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Affiliation(s)
- August A Olsen
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Laser A Bazancir
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stig Dahl
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daisuke Fukumori
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hironari Shiwaku
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Lars Bo Svendsen
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Strandby RB, Osterkamp JTF, Ambrus R, Henriksen A, Goetze JP, Secher NH, Achiam MP, Svendsen L. Mesenteric traction syndrome in pigs: A single-blinded, randomized controlled trial. Animal Model Exp Med 2021; 4:162-168. [PMID: 34179723 PMCID: PMC8212818 DOI: 10.1002/ame2.12160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Mesenteric traction syndrome is commonly observed in patients undergoing upper abdominal surgery and is associated with severe postoperative complications. A triad of hypotension, tachycardia, and facial flushing seems provoked by prostacyclin (PGI2) release from the gut in response to mesenteric traction. The administration of nonsteroidal anti-inflammatory drugs (NSAID) inhibits PGI2 release, stabilizing the hemodynamic response. Here, we examined the effect of mesenteric traction on splanchnic blood flow in pigs randomized to NSAID or placebo treatment. Materials and Methods Twenty pigs were allocated to either ketorolac or placebo treatment. Five minutes of manual mesenteric traction was applied. Plasma 6-keto-PGF1α, a stable metabolite of PGI2, hemodynamic variables, and regional blood flow (laser speckle contrast imaging) to the liver, stomach, small intestine, upper lip, and snout (laser Doppler flowmetry) were recorded prior to traction and 5 and 30 minutes thereafter. Results Both groups of pigs presented a decrease in systemic vascular resistance (P = .01), mean arterial blood pressure (P = .001), and blood flow in the gastric antrum (P = .002). Plasma 6-keto-PGF1α did not increase in either group (P = .195), and cardiac output, heart rate, central venous pressure, and blood flow to the liver, small intestine, upper lip, and snout remained unchanged. Conclusion Mesenteric traction resulted in cardiovascular depression, including reduced blood flow in the gastric antrum. Plasma 6-keto-PGF1α did not increase, and ketorolac administration did not alter the response to mesenteric traction. Furthers studies are needed to identify which substance is responsible for eliciting the cardiovascular response to mesenteric traction in pigs.
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Affiliation(s)
- Rune B. Strandby
- Department of Surgical Gastroenterology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Jens T. F. Osterkamp
- Department of Surgical Gastroenterology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Amelie Henriksen
- Department of Surgical Gastroenterology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Jens P. Goetze
- Department of Clinical Biochemistry, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Niels H. Secher
- Department of Anaesthesia, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Michael P. Achiam
- Department of Surgical Gastroenterology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
| | - Lars‐Bo Svendsen
- Department of Surgical Gastroenterology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
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Strandby RB, Ambrus R, Ring LL, Nerup N, Secher NH, Goetze JP, Achiam MP, Svendsen LB. Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy. Local Reg Anesth 2021; 14:33-42. [PMID: 33688249 PMCID: PMC7936689 DOI: 10.2147/lra.s294556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
Objective A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI2)-induced vasodilation and identified by facial flushing, tachycardia, and hypotension during abdominal surgery. We evaluated whether thoracic epidural anesthesia (TEA) influences the incidence of MTS. Design Randomized, blinded controlled trial. Setting Single-center university hospital. Participants Fifty patients undergoing open esophagectomy. Interventions Patients were randomized to either early (EA, after induction of general anesthesia) or late activation of TEA (LA, after re-established gastric continuity). Plasma 6-keto-PGF1α, a stable metabolite of PGI2 and interleukine-6 (IL6) were measured in plasma during surgery along with hemodynamic variables and MTS graded according to facial flushing together with plasma C-reactive protein on the third post-operative day. Results Forty-five patients met the inclusion criteria. Development of MTS tended to be more prevalent with EA (n=13/25 [52%]) than with LA TEA (n=5/20 [25%], p=0.08). For patients who developed MTS, there was a transient increase in plasma 6-keto-PGF1α by 15 min of surgery and plasma IL6 (p<0.001) as C-reactive protein (P<0.009) increased. EA TEA influenced the amount of phenylephrine needed to maintain mean arterial pressure >60 mmHg in patients who developed MTS (0.16 [0.016–0.019] mg/min vs MTS and LA TEA 0.000 [0.000–0.005] mg/min, p<0.001). Conclusion The incidence of MTS is not prevented by TEA in patients undergoing open esophagectomy. On the contrary, the risk of hypotension is increased in patients exposed to TEA during surgery, and the results suggest that it is advantageous to delay activation of TEA. Also, MTS seems to be associated with a systemic inflammatory response, maybe explaining the aggravated post-operative outcome.
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Affiliation(s)
- Rune B Strandby
- Department of Surgical Gastroenterology, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linea L Ring
- Department of Surgical Gastroenterology, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj Nerup
- Department of Surgical Gastroenterology, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels H Secher
- Department of Anesthesia, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars B Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Chen Z, Shao DH, Ma XD, Mao ZM. Dexmedetomidine aggravates hypotension following mesenteric traction during total gastrectomy: a randomized controlled trial. Ann Saudi Med 2020; 40:183-190. [PMID: 32493029 PMCID: PMC7270615 DOI: 10.5144/0256-4947.2020.183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mesenteric traction syndrome (MTS), which is characterized by arterial hypotension and tachycardia following mesenteric traction (MT), frequently occurs during abdominal surgery. Dexmedetomidine, commonly used in general anesthesia during major surgery, has a sympatholytic effect and attenuates the compensatory response to hypotension. OBJECTIVE Assess the effect of dexmedetomidine on hypotension following mesenteric traction. DESIGN Prospective, randomized, controlled clinical trial. SETTING Department of Anesthesiology, Zhenjiang First People's Hospital in China. PATIENTS AND METHODS Patients were randomly divided into three groups. Dexmedetomidine, 0.5 or 1.0 µg/kg, was intravenously administered over 15 minutes before skin incision followed by a maintenance rate of 0.5 µg/kg/h in groups D1 and D2, respectively; saline was administered in group C. MAIN OUTCOME MEASURE(S) The duration of hypotension, heart rate and plasma norepinephrine level in patients with MTS were recorded within 60 minutes following MT. SAMPLE SIZE 75 patients. RESULTS The duration of hypotension in the MTS patients in group D1 and D2 was significantly longer than that in groups C (D1 vs. C, P<.05; D2 vs. C, P<.01). Significantly more phenylephrine was required to treat hypotension in group D1 and D2 than was required for patients in group C (P<.05). The increase in heart rate during the first 15 minutes of MT in group D2 was significantly attenuated compared to that in group C (P<.0083). The increases in norepinephrine levels during the first 15 minutes of MT in group C were significantly higher than those in groups D1 and D2 (P<.0167). CONCLUSION Adjunctive dexmedetomidine in general anesthesia aggravates hypotension during MTS in open total gastrectomy. LIMITATIONS Postoperative complications were not evaluated. CONFLICT OF INTEREST None.
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Affiliation(s)
- Zheng Chen
- From the Department of Anesthesiology, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China
| | - Dong-Hua Shao
- From the Department of Anesthesiology, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China
| | - Xiao-Dong Ma
- From the Department of Anesthesiology, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China
| | - Zu-Min Mao
- From the Department of Anesthesiology, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China
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Development of a severe mesenteric traction syndrome during major abdominal surgery is associated with increased postoperative morbidity: Secondary data analysis on prospective cohorts. Langenbecks Arch Surg 2019; 405:81-90. [PMID: 31820096 DOI: 10.1007/s00423-019-01847-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/28/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE MTS is elicited during open abdominal surgery and is characterized by facial flushing, hypotension, and tachycardia in response to the release of prostacyclin (PGI2) to plasma. MTS seems to affect postoperative morbidity, but data from larger cohorts are lacking. We aimed to determine the impact of severe mesenteric traction syndrome (MTS) on postoperative morbidity in patients undergoing open upper gastrointestinal surgery. METHODS The study was a secondary analysis of data from three cohorts (n = 137). The patients were graded for severity of MTS intraoperatively, and hemodynamic variables and blood samples for plasma 6-keto-PGF1α, a stable metabolite of PGI2, were obtained at defined time points. Postoperative morbidity was evaluated by the comprehensive complication index (CCI) and the Dindo-Clavien classification (DC). RESULTS Patients undergoing either esophagectomy (n = 70), gastrectomy (n = 22), liver- (n = 23), or pancreatic resection (n = 22) were included. Severe MTS was significantly associated with increased postoperative morbidity, i.e., CCI ≥ 26.2 (OR 3.06 [95% CI 1.1-6.6]; p = 0.03) and risk of severe complications, i.e., DC ≥3b (OR 3.1 [95% CI 1.2-8.2]; p = 0.023). Furthermore, patients with severe MTS had increased length of stay (OR 10.1 [95% CI 1.9-54.3]; p = 0.007) and were more likely to be admitted to the intensive care unit (OR = 7.3 [95% CI 1.3-41.9]; p = 0.027), but there was no difference in 1-year mortality. CONCLUSION Occurrence of severe MTS during upper gastrointestinal surgery is associated with increased postoperative morbidity as indicated by an increased rate of severe complications, length of stay, and admission to the ICU. It remains to be determined whether inhibition of MTS enhances postoperative recovery.
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Ring LL, Strandby RB, Henriksen A, Ambrus R, Sørensen H, Gøtze JP, Svendsen LB, Achiam MP. Laser speckle contrast imaging for quantitative assessment of facial flushing during mesenteric traction syndrome in upper gastrointestinal surgery. J Clin Monit Comput 2018; 33:903-910. [PMID: 30460600 DOI: 10.1007/s10877-018-0226-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/16/2018] [Indexed: 11/28/2022]
Abstract
The mesenteric traction syndrome (MTS) is associated with prostacyclin (PGI2) facilitated systemic vasodilatation during surgery and is identified by facial flushing. We hypothesized that severe facial flushing would be related to the highest concentrations of plasma PGI2 and accordingly to the highest levels of skin blood flow measured by laser speckle contrast imaging (LSCI). Patients scheduled for major upper abdominal surgery were consecutively included. Within the first hour of the procedure, facial flushing was scored according to a standardized scale, and skin blood flow (LSPU) was continuously measured on the forehead and the cheeks by LSCI. Arterial blood samples for 6-keto-PGF1α (stable metabolite of PGI2) and hemodynamic variables were obtained at defined time points. Overall, 66 patients were included. After 15 min of surgery, patients with severe flushing demonstrated the highest plasma 6-keto-PGF1α concentration and the most significant decrease in systemic vascular resistance. Accordingly, the skin blood flow on the forehead (238 [201-372] to 562 LSPU [433-729]) and the cheeks (341 [239-355] to 624 LSPU [468-917]) increased and were significantly higher than for patients with moderate or no flushing (both, P = 0.04). A cut-off value for skin blood flow could be defined for both the cheeks and the forehead for patients with severe flushing vs. no flushing (425/456 LSPU, sensitivity 75/76% and specificity 80/85%). MTS is linked to an increase in facial skin blood flow during upper gastrointestinal surgery. By applying LSCI, it is possible to quantitatively register facial blood flow, and thereby provide an objective tool for intraoperative verification of MTS.
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Affiliation(s)
- Linea L Ring
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Rune B Strandby
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark.
| | - Amalie Henriksen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Henrik Sørensen
- Department of Anesthesia, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Jens P Gøtze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Lars B Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
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