Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016.

Rikard Ambrus; Michael P Achiam; Niels H Secher; Morten B S Svendsen; Kim Rünitz; Mette Siemsen; Lars B Svendsen

doi:10.1016/j.jamcollsurg.2017.06.003

Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016.

Rikard Ambrus, Michael P Achiam, Niels H Secher, Morten B S Svendsen, Kim Rünitz, Mette Siemsen, Lars B Svendsen

Institut for Klinisk Medicin

12 Citationer (Scopus)

Abstract

BACKGROUND: Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, in which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy.

STUDY DESIGN: Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA. Phenylephrine managed intraoperative hypotension and gastric microcirculation was assessed at antrum and corpus area by LSCI.

RESULTS: Antrum microcirculation (mean ± SD) was lower in the EA group at baseline (1,150 ± 189 laser speckle perfusion units [LSPU] vs LA group: 1,265 ± 163 LSPU; p = 0.036). In both groups, antrum microcirculation tended to decrease in response to anesthesia, TEA, and surgical procedure (LA: 1,265 ± 163 to 1,097 ± 184 LSPU, p = 0.021; EA: 1,150 ± 189 to 1,064 ± 177 LSPU, p = 0.093), with no difference between groups during the remaining laparotomy. Corpus microcirculation decreased in both groups from baseline to gastric pull-up in response to anesthesia, TEA, and surgery (LA: 1,081 ± 236 to 649 ± 165 LSPU, p < 0.001; EA: 1,011 ± 208 to 675 ± 178 LSPU, p < 0.001), but recovered after gastric continuity was re-established (EA to 795 ± 162 LSPU, p = 0.027; LA to 815 ± 166 LSPU, p = 0.014), with no significant differences between groups (p > 0.05). The EA group needed continued phenylephrine support to maintain blood pressure (216 ± 86 vs 58 ± 91 minutes; p < 0.001).

CONCLUSIONS: During esophagectomy, gastric microcirculation can be followed in real-time by LSCI. Flow changes in the stomach seemed related more to surgery than to TEA/vasopressor support. Laser speckle contrast imaging could form basis for directing procedures to maintain the microcirculation.

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Surgeons
Vol/bind	225
Udgave nummer	3
Sider (fra-til)	395-402
ISSN	1072-7515
DOI	https://doi.org/10.1016/j.jamcollsurg.2017.06.003
Status	Udgivet - 2017

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10.1016/j.jamcollsurg.2017.06.003

Citationsformater

Ambrus, R., Achiam, M. P., Secher, N. H., Svendsen, M. B. S., Rünitz, K., Siemsen, M., & Svendsen, L. B. (2017). Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016. Journal of the American College of Surgeons, 225(3), 395-402. https://doi.org/10.1016/j.jamcollsurg.2017.06.003

Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016. / Ambrus, Rikard; Achiam, Michael P ; Secher, Niels H et al.
I: Journal of the American College of Surgeons, Bind 225, Nr. 3, 2017, s. 395-402.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Ambrus, R, Achiam, MP , Secher, NH, Svendsen, MBS, Rünitz, K, Siemsen, M & Svendsen, LB 2017, 'Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016.', Journal of the American College of Surgeons, bind 225, nr. 3, s. 395-402. https://doi.org/10.1016/j.jamcollsurg.2017.06.003

Ambrus R, Achiam MP , Secher NH, Svendsen MBS, Rünitz K, Siemsen M et al. Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016. Journal of the American College of Surgeons. 2017;225(3):395-402. doi: 10.1016/j.jamcollsurg.2017.06.003

@article{face04c065d940188d5f00aca8dc4360,

title = "Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016.",

abstract = "BACKGROUND: Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, in which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy.STUDY DESIGN: Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA. Phenylephrine managed intraoperative hypotension and gastric microcirculation was assessed at antrum and corpus area by LSCI.RESULTS: Antrum microcirculation (mean ± SD) was lower in the EA group at baseline (1,150 ± 189 laser speckle perfusion units [LSPU] vs LA group: 1,265 ± 163 LSPU; p = 0.036). In both groups, antrum microcirculation tended to decrease in response to anesthesia, TEA, and surgical procedure (LA: 1,265 ± 163 to 1,097 ± 184 LSPU, p = 0.021; EA: 1,150 ± 189 to 1,064 ± 177 LSPU, p = 0.093), with no difference between groups during the remaining laparotomy. Corpus microcirculation decreased in both groups from baseline to gastric pull-up in response to anesthesia, TEA, and surgery (LA: 1,081 ± 236 to 649 ± 165 LSPU, p < 0.001; EA: 1,011 ± 208 to 675 ± 178 LSPU, p < 0.001), but recovered after gastric continuity was re-established (EA to 795 ± 162 LSPU, p = 0.027; LA to 815 ± 166 LSPU, p = 0.014), with no significant differences between groups (p > 0.05). The EA group needed continued phenylephrine support to maintain blood pressure (216 ± 86 vs 58 ± 91 minutes; p < 0.001).CONCLUSIONS: During esophagectomy, gastric microcirculation can be followed in real-time by LSCI. Flow changes in the stomach seemed related more to surgery than to TEA/vasopressor support. Laser speckle contrast imaging could form basis for directing procedures to maintain the microcirculation.",

keywords = "Adult, Aged, Esophagectomy, Female, Humans, Intraoperative Care/methods, Lasers, Male, Microcirculation, Middle Aged, Monitoring, Intraoperative/methods, Optical Imaging/methods, Prospective Studies, Single-Blind Method, Stomach/blood supply",

author = "Rikard Ambrus and Achiam, {Michael P} and Secher, {Niels H} and Svendsen, {Morten B S} and Kim R{\"u}nitz and Mette Siemsen and Svendsen, {Lars B}",

year = "2017",

doi = "10.1016/j.jamcollsurg.2017.06.003",

language = "English",

volume = "225",

pages = "395--402",

journal = "Journal of the American College of Surgeons",

issn = "1072-7515",

publisher = "Elsevier",

number = "3",

}

TY - JOUR

T1 - Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy

T2 - Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016.

AU - Ambrus, Rikard

AU - Achiam, Michael P

AU - Secher, Niels H

AU - Svendsen, Morten B S

AU - Rünitz, Kim

AU - Siemsen, Mette

AU - Svendsen, Lars B

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, in which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy.STUDY DESIGN: Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA. Phenylephrine managed intraoperative hypotension and gastric microcirculation was assessed at antrum and corpus area by LSCI.RESULTS: Antrum microcirculation (mean ± SD) was lower in the EA group at baseline (1,150 ± 189 laser speckle perfusion units [LSPU] vs LA group: 1,265 ± 163 LSPU; p = 0.036). In both groups, antrum microcirculation tended to decrease in response to anesthesia, TEA, and surgical procedure (LA: 1,265 ± 163 to 1,097 ± 184 LSPU, p = 0.021; EA: 1,150 ± 189 to 1,064 ± 177 LSPU, p = 0.093), with no difference between groups during the remaining laparotomy. Corpus microcirculation decreased in both groups from baseline to gastric pull-up in response to anesthesia, TEA, and surgery (LA: 1,081 ± 236 to 649 ± 165 LSPU, p < 0.001; EA: 1,011 ± 208 to 675 ± 178 LSPU, p < 0.001), but recovered after gastric continuity was re-established (EA to 795 ± 162 LSPU, p = 0.027; LA to 815 ± 166 LSPU, p = 0.014), with no significant differences between groups (p > 0.05). The EA group needed continued phenylephrine support to maintain blood pressure (216 ± 86 vs 58 ± 91 minutes; p < 0.001).CONCLUSIONS: During esophagectomy, gastric microcirculation can be followed in real-time by LSCI. Flow changes in the stomach seemed related more to surgery than to TEA/vasopressor support. Laser speckle contrast imaging could form basis for directing procedures to maintain the microcirculation.

AB - BACKGROUND: Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, in which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy.STUDY DESIGN: Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA. Phenylephrine managed intraoperative hypotension and gastric microcirculation was assessed at antrum and corpus area by LSCI.RESULTS: Antrum microcirculation (mean ± SD) was lower in the EA group at baseline (1,150 ± 189 laser speckle perfusion units [LSPU] vs LA group: 1,265 ± 163 LSPU; p = 0.036). In both groups, antrum microcirculation tended to decrease in response to anesthesia, TEA, and surgical procedure (LA: 1,265 ± 163 to 1,097 ± 184 LSPU, p = 0.021; EA: 1,150 ± 189 to 1,064 ± 177 LSPU, p = 0.093), with no difference between groups during the remaining laparotomy. Corpus microcirculation decreased in both groups from baseline to gastric pull-up in response to anesthesia, TEA, and surgery (LA: 1,081 ± 236 to 649 ± 165 LSPU, p < 0.001; EA: 1,011 ± 208 to 675 ± 178 LSPU, p < 0.001), but recovered after gastric continuity was re-established (EA to 795 ± 162 LSPU, p = 0.027; LA to 815 ± 166 LSPU, p = 0.014), with no significant differences between groups (p > 0.05). The EA group needed continued phenylephrine support to maintain blood pressure (216 ± 86 vs 58 ± 91 minutes; p < 0.001).CONCLUSIONS: During esophagectomy, gastric microcirculation can be followed in real-time by LSCI. Flow changes in the stomach seemed related more to surgery than to TEA/vasopressor support. Laser speckle contrast imaging could form basis for directing procedures to maintain the microcirculation.

KW - Adult

KW - Aged

KW - Esophagectomy

KW - Female

KW - Humans

KW - Intraoperative Care/methods

KW - Lasers

KW - Male

KW - Microcirculation

KW - Middle Aged

KW - Monitoring, Intraoperative/methods

KW - Optical Imaging/methods

KW - Prospective Studies

KW - Single-Blind Method

KW - Stomach/blood supply

U2 - 10.1016/j.jamcollsurg.2017.06.003

DO - 10.1016/j.jamcollsurg.2017.06.003

M3 - Journal article

C2 - 28669885

SN - 1072-7515

VL - 225

SP - 395

EP - 402

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

IS - 3

ER -

Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy: Presented at the Annual Meeting of the Danish Surgical Society, Copenhagen, Denmark, November 2016.

Abstract

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