INFLUENCE OF PROSTAGLANDIN E(1) ON TISSUE ISCHEMIA DURING SURGICAL REPAIR OF THE ABDOMINAL-AORTA

Objective: To evaluate tissue protection by PGE(1) during leg ischemia in patients undergoing aortic surgery. Design: Randomized, controlled prospective clinical trial. Setting: Single university hospital. Part icipants: 19 consecutive patients undergoing abdominal aortic aneurysm repair. Interventions: Patients received infusions of 30 ng/kg/min of PGE(1) or saline. Measurements and Main Results: Hemodynamic variable s. lactate, creatine phosphokinase, and thromboxane B-2 (TXB(2)) were measured. In the control group, the decrease in cardiac index (CI) aft er aortic cross-clamping (AXC) persisted until unclamping together wit h a decrease in femoral venous O-2 content (CfvO2). In the PGE(1) grou p, CI returned to baseline with a trend toward greater CfvO2 levels. D uring reperfusion in the PGE(1) group, O-2 consumption and lactate lev els exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB(2), which was not altere d by surgery or by PGE(1) infusion. Conclusions: Intraoperative PGE(1) treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxyg en utilization in a manner that overwhelms any possible protective eff ect. (C) 1996 by W.B. Saunders Company