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BJA Advance Access originally published online on August 30, 2009
British Journal of Anaesthesia 2009 103(5):691-700; doi:10.1093/bja/aep239
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Arginine-vasopressin attenuates beneficial norepinephrine effect on jejunal mucosal tissue oxygenation during endotoxinaemia

S. Maier1, W. Hasibeder4, W. Pajk1, C. Hengl1, H. Ulmer2, H. Hausdorfer3, B. Wurzinger4 and H. Knotzer1,*

1 Department of Anaesthesiology and Critical Care Medicine,
2 Department for Medical Statistics, Informatics and Health Economics and
3 Department of Hygiene, Microbiology, and Social Medicine, Innsbruck Medical University, Innsbruck, Austria
4 Department of Anaesthesiology and Critical Care Medicine, Krankenhaus der Barmherzigen Schwestern Ried, Austria

* Corresponding author. E-mail: johann.knotzer{at}uki.at

Background: The objective of the present study was to investigate the effects of increasing doses of norepinephrine (NE) with or without arginine-vasopressin (AVP) on intestinal oxygen supply and jejunal mucosal tissue oxygen tension in an acute endotoxic pig model.

Methods: In this prospective, randomized, experimental study on 24 domestic pigs, jejunal mucosal tissue PO2 (PO2muc) was measured using two Clark-type surface oxygen electrodes. Oxygen saturation of jejunal microvascular haemoglobin (HbO2j) was determined by tissue reflectance spectrophotometry. Systemic haemodynamic variables, mesenteric-venous and systemic acid–base and blood gas variables, and lactate measurements were recorded. Measurements were performed at baseline, after Escherichia coli lipopolysaccharide (LPS) administration, and at 20 min intervals during incremental NE infusion (0.05, 0.1, 0.5, 1.0, and 2 µg kg–1 min–1, respectively) with 57 mU kg–1 h–1 AVP (n=8; NE+AVP group) or without (n=8; NE group); or infusion of an equal amount of normal saline (n=8; CON group).

Results: LPS infusion led to a significant (P<0.05) decrease of PO2muc and HbO2j. Both NE and NE+AVP increased arterial pressure, cardiac output, and mesenteric artery blood flow. Concomitant to an increase in systemic oxygen delivery, NE improved PO2muc and HbO2j. NE alone was superior in restoration of PO2muc when compared with NE+AVP.

Conclusions: Both NE and NE+AVP improved global haemodynamics and systemic oxygen transport variables when compared with control animals in an acute endotoxic pig model. NE improved jejunal PO2muc at all dosages. NE effects were significantly blunted by simultaneous administration of AVP.

Keywords: blood, flow; gastrointestinal tract, mucosal perfusion; microcirculation; oxygen, tissue


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