Maria A M Salgado1, Marcelo F Salgado-Filho1, José O Reis-Brito1, Marcos A Lessa2, Eduardo Tibirica3. 1. National Institute of Cardiology, Ministry of Health. 2. Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil. 3. National Institute of Cardiology, Ministry of Health; Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil. Electronic address: etibi@ioc.fiocruz.br.
Abstract
OBJECTIVES: To evaluate the effectiveness of single-point laser Doppler perfusion monitoring (LDPM) in the assessment of microvascular reactivity in the skin during cardiopulmonary bypass (CPB). DESIGN: Cross-sectional observational study. SETTING: Government-affiliated teaching hospital. PARTICIPANTS: Twenty male patients aged 60 ± 2 years who underwent coronary artery bypass grafting under CPB. INTERVENTIONS: The authors assessed the endothelium-dependent vasodilation of the skin microcirculation at the forehead and forearm using LDPM coupled with thermal hyperemia. This measurement was performed before and after the induction of anesthesia, during and after CPB, and 24 h after the end of the surgical procedure. RESULTS: The basal values of microvascular flow before the induction of anesthesia were significantly higher in the skin of the forehead compared with that of the forearm. There were no significant alterations in microvascular reactivity throughout the recording periods for both recording sites, as assessed by the vasodilation range expressed as cutaneous vascular conductance (arbitrary perfusion units/mean arterial pressure). CONCLUSIONS: Using LDPM, the authors showed that the microcirculatory bed of the skin of the forehead, which is readily accessible during cardiac surgery, is a suitable model for the study of microvascular reactivity and tissue perfusion in cardiovascular surgical procedures using CPB. This technique could, thus, be suitable for evaluating the effects of drugs or technical procedures on tissue perfusion during cardiac surgery under cardiopulmonary bypass.
OBJECTIVES: To evaluate the effectiveness of single-point laser Doppler perfusion monitoring (LDPM) in the assessment of microvascular reactivity in the skin during cardiopulmonary bypass (CPB). DESIGN: Cross-sectional observational study. SETTING: Government-affiliated teaching hospital. PARTICIPANTS: Twenty male patients aged 60 ± 2 years who underwent coronary artery bypass grafting under CPB. INTERVENTIONS: The authors assessed the endothelium-dependent vasodilation of the skin microcirculation at the forehead and forearm using LDPM coupled with thermal hyperemia. This measurement was performed before and after the induction of anesthesia, during and after CPB, and 24 h after the end of the surgical procedure. RESULTS: The basal values of microvascular flow before the induction of anesthesia were significantly higher in the skin of the forehead compared with that of the forearm. There were no significant alterations in microvascular reactivity throughout the recording periods for both recording sites, as assessed by the vasodilation range expressed as cutaneous vascular conductance (arbitrary perfusion units/mean arterial pressure). CONCLUSIONS: Using LDPM, the authors showed that the microcirculatory bed of the skin of the forehead, which is readily accessible during cardiac surgery, is a suitable model for the study of microvascular reactivity and tissue perfusion in cardiovascular surgical procedures using CPB. This technique could, thus, be suitable for evaluating the effects of drugs or technical procedures on tissue perfusion during cardiac surgery under cardiopulmonary bypass.
Authors: Daniel Keene; Matthew J Shun-Shin; Ahran D Arnold; James P Howard; David Lefroy; D Wyn Davies; Phang Boon Lim; Fu Siong Ng; Michael Koa-Wing; Norman A Qureshi; Nick W F Linton; Jaymin S Shah; Nicholas S Peters; Prapa Kanagaratnam; Darrel P Francis; Zachary I Whinnett Journal: JACC Clin Electrophysiol Date: 2019-03-27