A comparison among portal lactate, intramucosal sigmoid Ph, and deltaCO2 (PaCO2 - regional Pco2) as indices of complications in patients undergoing abdominal aortic aneurysm surgery.

Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative organ failure and intraoperative changes in arterial and portal blood lactate; changes in intramucosal sigmoid pH (pHi); differences between sigmoid Pco(2) and arterial Pco(2) (DeltaCO(2)); and hemoglobin (Hb). Hb, arterial blood lactate concentrations, pHi, and DeltaCO(2) (air tonometry) were recorded at the start of anesthesia (T0), before aorta clamping (T1), 30 minutes after clamping (T2), and at the end of surgery (T3). Portal venous lactate concentrations were recorded at T1 and T2.

[Fenoldopam and kidney function in a case of abdominal aortic pseudoaneurysm with supra-renal clamping in an emergency protocol].

The renal haematic flow decrease, the vasoconstriction and the local vascular resistance increase, associated with descending aortic cross-clamping, before the origin of renal arteries, can be contrasted by continuous infusion of fenoldopam, a dopamine analog with selective action on DA1-receptors. The renal effects of this molecule are renal plasmatic flow increase and local vascular resistance decrease, without important haemodynamic changes, with mild cardiovascular modification, even at high doses, in hypertensive and non hypertensive patients, also in normal volume condition and hypovolemic condition. This selective action at renal level allows the use of fenoldopam also in surgical emergencies, in patients with low cardiovascular function.

Predictive value of interleukin 6 (IL-6), interleukin 8 (IL-8) and gastric intramucosal pH (pH-i) in major abdominal surgery.

Objective: To study plasma concentrations of interleukin 6 (IL-6) and interleukin 8 (IL-8) in patients with splanchnic hypoxia, as documented by gastric intramucosal measurements (pH-i), during major abdominal surgery and the relationship between IL-6 and IL-8 concentrations and postoperative complications as well as clinical outcome.

Design: A prospective study.

Patients: Twelve patients scheduled for major abdominal surgery with no evidence of coexisting infectious disease.

[Intraoperative lactic acidosis, can it be treated? Clinico-experimental, prospective, sequential study].

Objective: To verify the efficacy and absence of risk attributable to therapy with alkaline solutions for correction of lactic acidosis and to demonstrate the usefulness of L-carnitine in converting lactate into pyruvate in conditions of good blood oxygenation.

Design: Prospective study on a consecutive series of patients subdivided into three groups following the use of: alkalinizing therapy (group I), L-carnitine (group II), or saline solution (group III). Groups 1 and 2 were further subdivided into subgroups "a" and "b" according to the type of alkalinizing agent and of L-carnitine somministration.