AUTHOR=Olesen Niels D. , Egesborg Astrid H. , Frederiksen Hans-Jørgen , Svendsen Lars B. , Secher Niels H. 

TITLE=The effect of a mesenteric traction syndrome on internal carotid artery blood flow

JOURNAL=Frontiers in Anesthesiology

VOLUME=2

YEAR=2023

URL=https://www.frontiersin.org/journals/anesthesiology/articles/10.3389/fanes.2023.1101013

DOI=10.3389/fanes.2023.1101013

ISSN=2813-480X

ABSTRACT=<sec><title>Purpose</title><p>During abdominal surgery, manipulation of internal organs may induce a “mesenteric traction syndrome” (MTS) including a triad of flushing, hypotension, and tachycardia that lasts for approximately 30 min. We evaluated whether MTS affects internal carotid artery blood flow.</p></sec><sec><title>Methods</title><p>This prospective cohort study included 27 patients aged 65 ± 11 years (mean ± SD) undergoing stomach resection (<italic>n</italic> = 12), esophageal resection (<italic>n</italic> = 14), or gastro-entero anastomosis (<italic>n</italic> = 1) during propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound determined internal carotid artery blood flow, laser Doppler flowmetry assessed forehead skin blood flow, and near-infrared spectroscopy determined cerebral oxygenation. Development of MTS was defined by flushing within 60 min after incision.</p></sec><sec><title>Results</title><p>Seven patients developed MTS 22 [20–26; median (IQR)] min after incision and at that time the change in heart rate (to 87 ± 13 vs. 70 ± 11 bpm; <italic>P</italic> = 0.0007) and skin blood flow (to 214 (134–269) vs. 84 (59-112 PU; <italic>P</italic> = 0.0044) was higher in the patients who developed MTS as compared to those who did not, while mean arterial pressure (63 ± 13 vs. 64 ± 14 mmHg; <italic>P</italic> = 0.1433), cerebral oxygenation (69 ± 9% vs. 63 ± 10%; <italic>P</italic> = 0.2485), and internal carotid artery flow (225 ± 53 vs. 203 ± 69 ml/min; <italic>P</italic> = 0.9529) were similar.</p></sec><sec><title>Conclusion</title><p>Hemodynamic perturbations are observed in some patients in response to manipulation of the viscera, but the development of MTS appears not to influence internal carotid artery flow.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT02951273?term=NCT02951273&amp;rank=1" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT02951273?term=NCT02951273&amp;rank=1</ext-link>, identifier: NCT02951273.</p></sec>