Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients:A Systematic Review and Meta-analysis

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia.Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed,Web of Science,the Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang Data were searched for randomized-controlled trials(RCTs)on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September,2021.The standardized mean differences(SMD)with 95%confidence interval(CI)were employed to analyze the data.The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients(dexmedetomidine group,546 patients;control group,287 patients)were included.There was no significant increase in perioperative heart rate(HR),mean arterial pressure(MAP),and diastolic blood pressure(DBP)in the dexmedetomidine group before and during the operation.In addition,the variations of hemodynamic indexes including HR,MAP,SBP(systolic blood pressure),and DBP were significantly lower in the dexmedetomidine group compared with the control group(HR:SMD=-0.87,95%CI:-1.13 to-0.62;MAP:SMD=-1.12,95%CI:-1.60 to-0.63;SBP:SMD=-1.27,95%CI:-2.26 to-0.27;DBP:SMD=-0.96,95%CI:-1.33 to-0.59).Subgroup analysis found that with the prolongation of 1.0μg/kg dexmedetomidine infusion,the patient’s heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients.However,further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.

One in four patients with gastrointestinal bleeding develops shock or hemodynamic instability:A systematic review and meta-analysis

BACKGROUND Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding.However,there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal bleeding.AIM To determine the pooled event rates in the available literature and specify them based on the bleeding source.METHODS The protocol was registered on PROSPERO in advance(CRD42021283258).A systematic search was performed in three databases(PubMed,EMBASE,and CENTRAL)on 14^(th) October 2021.Pooled proportions with 95%CI were calculated with a random-effects model.A subgroup analysis was carried out based on the time of assessment(on admission or during hospital stay).Heterogeneity was assessed by Higgins and Thompson’s I^(2) statistics.The Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias assessment.The Reference Citation Analysis(https://www.referencecitationanalysis.com/)tool was applied to obtain the latest highlight articles.RESULTS We identified 11589 records,of which 220 studies were eligible for data extraction.The overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25(95%CI:0.17-0.36,I^(2)=100%).In non-variceal bleeding,the proportion was 0.22(95%CI:0.14-0.31,I^(2)=100%),whereas it was 0.25(95%CI:0.19-0.32,I^(2)=100%)in variceal bleeding.The proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12(95%CI:0.06-0.22,I^(2)=90%).The risk of bias was low,and heterogeneity was high in all analyses.CONCLUSION One in five,one in four,and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal,variceal,and colonic diverticular bleeding,respectively.

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinicalfeatures and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients whounderwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVRindex (SVRI) ≥ 20;B, CI < 3, SVRI ≥ 20;C, CI ≥ 3, SVRI < 20;and D, CI < 3, SVRI < 20. The primary outcome wasfreedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant,and death. Clinical and hemodynamic variables and freedom from the endpoint were compared betweenthe hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients wereincluded. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. Allthe patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascularresistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category Dhad a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category Dwere outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamicprofiling.

Spatiotemporal hemodynamic monitoring via configurable skin-like microfiber Bragg grating group

Systemic blood circulation is one of life activity’s most important physiological functions.Continuous noninvasive hemodynamicmonitoring is essential for the management of cardiovascular status.However,it is difficult to achieve systemichemodynamic monitoring with the daily use of current devices due to the lack of multichannel and time-synchronized operationcapability over the whole body.Here,we utilize a soft microfiber Bragg grating group to monitor spatiotemporalhemodynamics by taking advantage of the high sensitivity,electromagnetic immunity,and great temporal synchronizationbetween multiple remote sensor nodes.A continuous systemic hemodynamic measurement technique is developedusing all-mechanical physiological signals,such as ballistocardiogram signals and pulse waves,to illustrate the actualmechanical process of blood circulation.Multiple hemodynamic parameters,such as systemic pulse transit time,heartrate,blood pressure,and peripheral resistance,are monitored using skin-like microfiber Bragg grating patches conformallyattached at different body locations.Relying on the soft microfiber Bragg grating group,the spatiotemporal hemodynamicmonitoring technique opens up new possibilities in clinical medical diagnosis and daily health management.

Preliminary Evaluation of Hemodynamic Effects of Fontan Palliation on Renal Artery Using Computational Fluid Dynamics

Background:The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation.To know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury(AKI)and the postoperative complications.However,the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery(RA).Methods:We reconstructed a three-dimensional(3D)vascular model of a patient requiring Fontan palliation.The technique of computational fluid dynamics(CFD)was utilized to explore the changes of RA hemodynamics under different possible blood flow rates.The relationship between the kidney perfusion and hemodynamic characteristics was investigated.Results:The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate decreased.When the flow rate decreased to two-thirds of its baseline,both the pressure of left renal artery(LRA)and the pressure of right renal artery(RRA)dipped below 50%,and the pressure of RRA fell more quickly than that of LRA.Uneven distribution of WSS was observed on the trunk of RA,and the lowest WSS was found at the distal of RA.The average WSS in RA dropped to around 50%as the flow rate reached one-third of its baseline.Conclusions:As a promising approach,CFD can be utilized to quantitatively evaluate the hemodynamic characteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function,to help realize better prognosis for the patients with Fontan palliation.

Effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing resection of rectal carcinoma

BACKGROUND Rectal carcinoma(RC)treatment primarily involves laparoscopic surgery,which may induce significant hemodynamic changes and weaken immune function.Certain anesthetic approaches using opioid drugs(including remifentanil and sufentanil)pose risks,such as hypotension.AIM To determine the effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing RC resection.METHODS A total of 211 patients one hundred and four patients with RC treated at the First Affiliated Hospital of Dalian Medical University between November 2018 and November 2022 were retrospectively analyzed.Among them,the remifentanil group included 45 patients receiving remifentanil with propofol anesthesia and the sufentanil group included 59 patients receiving sufentanil with propofol anesthesia.Changes in the hemodynamic index,oxidative stress index,general data,consumption of remifentanil,and use of vasoactive drugs were compared.The incidences of adverse reactions were calculated.RESULTS The two groups did not significantly differ in terms of operation,anesthesia,and extubation times(P>0.05).At 1 min after intubation,the sufentanil group showed a notably higher heart rate,systolic blood pressure(SBP),diastolic blood pressure,and mean arterial pressure(MAP)compared with the remifentanil group(P<0.05),whereas the sufentanil group showed a notably higher SBP and MAP compared with the remifentanil group at 5 min after pneumoperitoneum(P<0.05).Thirty minutes after surgery,the remifentanil group showed significantly lower plasma cortisol,noradrenaline,and glucose levels than the sufentanil group(P<0.001).The remifentanil group consumed significantly less remifentanil than the sufentanil group(P<0.05),and the adoption frequency of ephedrine was lower in the remifentanil group than that in the sufentanil group(P<0.05).The incidence of hypotension was notably higher in the sufentanil group than that in the remifentanil group(P<0.05).CONCLUSION Remifentanil combined with propofol can improve hemodynamics and relieve oxidative stress in patients undergoing RC resection.

Research progress on the influence of local hemodynamics on carotid atherosclerosis

The reasons for the formation of atherosclerosis are diverse and complex,and atherosclerosis as a kind of systemic disease has the characteristics of focal selectivity,which occurs in the carotid bifurcation.The feature enables a large number of studies have found that the severe local hemodynamic characteristics has a great influence to the occurrence of this disease.This paper briefly reviews the related research on the local hemodynamics of carotid bifurcation.The relevant parameters of local hemodynamics were sorted out and summarized,and the effects of wall shear force and its derived parameters on the generation,progression and rupture of carotid atherosclerosis and their clinical applications were reviewed,in order to provide mechanical information for the early warning of carotid plaque rupture.At the same time,this paper describes the transformation of local hemodynamics research in the clinical application of carotid atherosclerosis disease,in order to provide personalized selection and basis for the clinical treatment of this disease.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function

BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.

Hemodynamic Fetal Response to Maternal Isometric Exercise in Pregnant Patients with Hypertension

Objective: to evaluate the maternal-fetal hemodynamic response with Doppler in pregnant women with chronic arterial hypertension and preeclampsia submitted to controlled isometric activity. Methods: experimental study comparing 50 healthy and 26 hypertensive and 24 preeclamptic pregnant women, from 26 to 36 weeks of gestational age, submitted to isometric contraction with handgrip dynamometer. Maternal hemodynamic parameters (systolic and diastolic blood pressure;heart rate;uterine arteries Doppler) and fetal (heart rate;umbilical artery, middle cerebral and venous duct Doppler) were evaluated before, during and post-isometry. Results: in preeclampsia were observed higher values of blood pressure and uterine artery indexes in all times;middle cerebral artery indexes in the pre and post-isometry;and of maternal heart rate post-isometry. In hypertensive women, systolic blood pressure is increased all the times, with indexes of the right uterine and middle cerebral arteries higher in pre-isometry;middle cerebral and umbilical arteries greater during isometry;and maternal heart rate and umbilical artery indexes bigger after isometry. Conclusion: blood pressure is higher in preeclamptic and hypertension women. The right uterine artery has more resistance in preeclampsia, with a significant decrease in pre to isometry in hypertensive and preeclamptic women;and increased in contraction to post-isometry in healthy and hypertensive women. The left uterine artery increases resistance post-isometry in all groups. The fetal hemodynamic parameters did not show significant differences when comparing the before, during and post-isometry.

Hemodynamic Fetal Response to Maternal Isometric Exercise in Pregnant Patients with Diabetes

Background: Studies on physical activity during pregnancy and its impact on mother and fetus are still limited. International protocols consider only aerobic exercise and fail to provide information about other modalities such as isometric exercise. Isometric exercise promotes cardiorespiratory resistance and muscle strengthening, but it is rarely tested on pregnant women because it increases maternal blood pressure and can subsequently affect placental circulation. Objectives: To assess the fetal response by use of Doppler study in diabetes pregnant women submitted to isometric exercise. Methods: A cross-sectional experimental study was conducted on 25 diabetes pregnant women with gestational age between 26 and 36 weeks. The patients were submitted to isometric handgrip, and data were collected from the mother (blood pressure, heart rate and Doppler velocimetry for the uterine arteries) and from the fetus (heart rate, Doppler velocimetry for the umbilical artery, middle cerebral artery and ductus venosus). All variables were collected before, during and after the isometric handgrip. Results: There was a significant reduction in the pulsatilityindex (average values pre 0.77 ± 0.30, trans 0.65 ± 0.22, and post 0.75 ± 0.22, with p = 0.001), resistance index (average values pre 0.49 ± 0.12, trans 0.44 ± 0.10, and post 0.48 ± 0.90, with p =

Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy:Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

Noninvasive Hemodynamic Monitoring for Heart Failure:A New Era of Heart Failure Management

Despite the development of noninvasive tools as echocardiography,right-sided heart catheterization remains an integral part of the cardiovascular evaluation.In the last decade,better understanding of the hemodynamic process before heart failure decompensation led to improvement of outpatient strategies to prevent it.Advances in implantable wireless technology now allow frequent and direct measurement of intracardiac fi lling pressures,which can be monitored by health care providers to help tailor therapy to reduce fi lling pressures and hospital readmission rates.

Effects of Captopril and Nadolol on Renal Hemodynamics in Patients with Essential Hypertension

The randomized single-blind study was designed to compare the effects of captopril Cap),and nadolol(And)on renal hemodynamics in 60 patients with essential hyperttnsion.They were divided into two groups at random.Cap was given in dosage of 37.5-75 mg/d per os and And 40-80 mg/d.The results show that both drugs increase the blood volume distributed to the kidneys from cardiac output(renal blood flow/cardiac output),Cap increasing 10% (P<0. 05) and And 8%(F<0.05) Renal vascular resistance(RVR)is lowered by the two drugs,13%(P<0. 05) by Cap and 11%(P<0.05) by And.These suggest that both drugs facilitate the maintenance of renal blood circulation in patients with essential hypeitension.being beneficial for long-term treatment of hypertension.

Effects of rh BNP after PCI on non-invasive hemodynamic in acute myocardial infarction patients with left heart failure

Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.

Clinical and experimental study of effect of Raondix Salviae Militiorhiza and other blood-activating and stasis-eliminating Chinese herbson hemodynamics of portal hypertension

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Effects of combined splenorenal shunt devascularization and devascularization only on hemodynamics of the portal venous system in patients with portal hypertension

Shunt and devascularization have totally different effects on hemodynamics of the portal venous system , and the actual results of combined shunt and devascularization should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics of the portal venous system after conventional spleno-renal shunt combined with pericardial devascularization and pericardial devascularization only. METHODS: In 20 patients who had received conventional splenorenal shunt combined with pericardial devascularization(CP) and 18 who had received pericardial devascularization and splenectomy (PCDV), hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure was detected continuously by a transducer during the operation. RESULTS: Compared to the preoperative data, a decreased flow of the portal vein (PVF) (563.12±206.42 ml/min vs 1080.63±352.85 ml/min, P<0.05), a decreased diameter of the portal vein (PVD) (1.20±0.11 cm vs 1.30±0.16 cm, P<0.01 ), a decreased free portal preasure ( FPP ) (21.50±2.67 mmHg vs 29.88±2.30 mmHg, P<0.01) and an increased flow of the superior mesenteric vein (SMVF) (1105.45±309.03 ml/min vs 569.13±178.46 ml/min, P < 0.05) were found in the CP group after operation; a decreased PVD (1.27±0.16 cm vs 1.40±0.23 cm, P<0.05), a decreased PVF (684.60±165.73 ml/min vs 1175.64±415.09 ml/min, P<0.05), a decreased FPP (24.40±3.78 mmHg vs 28.80±3.56 mmHg, P<0.05) and an increased SMVF (697.91+121.83 ml/min vs 521.30±115.82 ml/min, P<0.05) were found in the PCDV group. After operation, the PVF of CP group (563.12±206.42 ml/min vs 684.60±165.73 ml/min, P>0.05) was not decreased significantly while FPP (21.50±2.67 mmHg vs 24.40±3.78 mmHg, P< 0.01) was decreased significantly as compared with that of the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP is much better in the combined procedures than in PCDV. Since there is no significant difference in PVF between the two groups, the combined procedures could integrate advantages of shunt with those of the devascularization, maintaining the normal anatomy structure of the hepatic portal vein, and should be one of the best choices for patients with PHT when surgical interventions are considered.

Effects of somatostatin on splanchnic hemodynamics in cirrhotic patients with portal hypertension

INTRODUCTIONEsophageal variceal bleeding (EVB) is one of themost common complications of cirrhosis with portalhypertension.In recent years,great progress hasbeen made in medicinal treatment.Somatostatin hasbeen widely used in clinics,for it can effectivelylower the portal venous pressure (PVP) with

Early changes of hepatic hemodynamics measured by functional CT perfusion in a rabbit model of liver tumor

BACKGROUND:Early detection and treatment of hepatocellular carcinoma is crucial to improving the patients’ survival.The hemodynamic changes caused by tumors can be serially measured using CT perfusion.In this study,we used a CT perfusion technique to demonstrate the changes of hepatic hemodynamics in early tumor growth,as a proof-of-concept study for human early hepatocellular carcinoma.METHODS:VX2 tumors were implanted in the liver of ten New Zealand rabbits.CT perfusion scans were made 1 week(early) and 2 weeks(late) after tumor implantation.Ten normal rabbits served as controls.CT perfusion parameters were obtained at the tumor rim,normal tissue surrounding the tumor,and control liver;the parameters were hepatic blood flow,hepatic blood volume,mean transit time,permeability of capillary vessel surface,hepatic arterial index,hepatic arterial perfusion and hepatic portal perfusion.Microvessel density and vascular endothelial growth factor were correlated.RESULTS:At the tumor rim,compared to the controls,hepatic blood flow,hepatic blood volume,permeability of capillary vessel surface,hepatic arterial index,and hepatic arterial perfusion increased,while mean transit time and hepatic portal perfusion decreased on both early and late scans(P<0.05).Hepatic arterial index increased(135%,P<0.05),combined with a sharp increase in hepatic arterial perfusion(182%,P<0.05) and a marked decrease in hepatic portal perfusion(-76%,P<0.05) at 2 weeks rather than at 1 week(P<0.05).Microvessel density and vascular endothelial growth factor showed significant linear correlations with hepatic blood flow,permeability of capillary vessel surface and hepatic arterial index,but not with hepatic blood volume or mean transit time.CONCLUSION:The CT perfusion technique demonstrated early changes of hepatic hemodynamics in this tumor model as proof-of-concept for early hepatocellular carcinoma detection in humans.

Goal-directed therapy in intraoperative fluid and hemodynamic management

Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.

Nitric oxide synthase distribution in esophageal mucosa and hemodynamic changes in rats with cirrhosis

AIM To observe the nitric oxide synthase (NOS) distribution in the esophageal mucosa andhemodynamic changes in cirrhotic rats.METHODS NOS distribution in the loweresophagus of rats with carbon tetrachlorideinduced cirrhosis was assessed by using NADPHdiaphorase (NADPH-d ) histochemical method.Concentration of NO in serum were measured byfluorometric assay. Mean arterial pressure(MAP), cardiac output (CO), cardiac index (CI),splanchnic vascular resistance (SVR ), andsplanchnic blood flow (SBF ) were alsodetermined using 5’CO-labeled microspheretechnique.RESULTS Intensity of NOS staining in theesophageal epithelium of cirrhotic rats wassignificantly stronger than that in controls.There was a NOS--positive staining area in theendothelia of esophageal submucosal vessels ofcirrhotic rats, but the NOS staining was negativein normal rats. NO concentration of serum incirrhotic rats were significantly higher incomparison with that of controls. Cirrhotic ratshad significantly lower MAP, SVR and higherSBF than those of the controls.CONCLUSION SPlanchnic hyperdynamiccirculatory state was observed in rats withcirrhosis. The endogenous NO may play animportant role in development of esophagealvarices and in changes of hemodynamics incirrhosis.