Increasing cardiac output by fluid loading: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation

Abstract

Increasing cardiac output to supranormal values by fluid loading is not associated with a significant change in ICG-PDR or gastric mucosal PRco2.

Levobupivacaine plasma concentrations following major liver resection

“…Following a bolus of ICG (0.25 mg/kg body weight dissolved in 10 ml water) via a central venous catheter, the plasma disappearance rate (PDR) can be measured noninvasively with a finger clip in percent per minute [8,9].…”

“…However, indocyanine green (ICG) clearance can give information independent of these effects [8][9][10][11].…”

Perioperative liver protection

“…Although the rate of biotransformation is considered minimal, some authors consider isoflurane as the causative agent for a wide spectrum of hepatic injuries, ranging from postoperative transaminitis to fulminant hepatic failure and death [35][36][37][38][39]. In contrast, a beneficial effect of isoflurane could be shown on hepatic blood supply, possibly due to direct 14 [C] aminopyrine 14 [C] erythromycin 14 [C] methacetin 14 [CO 2 ] exhalation AP, alkaline phosphatase; ASAT, aspartate aminotransferase; GLDH, glutamate dehydrogenase; g-GT, glutamyl transferase. Data from [30].…”

“…Yet, the splanchnic blood supply is highly variable and does not necessarily increase in conjunction with a stable or increased cardiac output [14,15]. It is generally agreed, though, that a reduction in cardiac output, systemic vascular resistance or an increase in right atrial pressure may all jeopardize the hepatic nutritive blood flow [16][17][18].…”

Targeting the microcirculation in resuscitation of acutely unwell patients

“…However, other studies have already reported inconstant improvement of microcirculatory gastric perfusion evaluated by gastric tonometry (gastric pHi), despite a clear improvement in CO following fluid loading in septic-shock patients [9,10] and in postoperative cardiac surgery [11]. Intravenous fluid therapy was guided by measurements of central venous pressure (CVP group) or stroke volume (SV group).…”