Treatment of microcirculatory disorders by administration of a small volume hypertonic saline ("small-volume resuscitation") in acute experimental pancreatitis

Background: The prophylactic and therapeutic effect of a small volume of hy pertonic saline (small-volume resuscitation) on pancreatic microcirculation was observed in acute pancreatitis of graded severity. Methods: The pancreatitis was induced by infusion of normal saline (0.9 %, 0.4 ml; i.d.), taurocholic acid (4%, 0.4 ml), the combination of glycodeoxy cholic acid (10 mmol/l, 1.0 ml/kg KG) and cerulein (5 mu/kg KG/Std., i.v.), or cerulein (5 mu/kg KG/Std., i.v.) alone. After injecting Acridine Orange to label leukocytes, pancreatic microcirculation was observed in-vivo with a epiluminescent microscope and recorded on videotape. Results: In hemorrhagic necrotizing pancreatitis receiving prophylactic tre atment 5 min prior to induction of the pancreatitis, microcirculation was p reserved in 55% of capillary fields. The capillary flow rate was 1 and the number of perfused capillaries 76%. Postcapillary venular leukocyte adheren ce was 45% of vein cross section. The median histopathologic damage scored 8 points. In controls a complete microcirculatory breakdown was observed an d in the group with treatment 5 min after induction of the pancreatitis no significant difference was detected. In intermediate pancreatitis the numb er of perfused capillaries remained 55.0% vs. 23.3%, at a capillary flow ra te of 2 vs. 1 in controls. Leukocyte adherence was 40.0% vs. 51.7%. The his topathologic damage scored 6.0 vs. 9.0 points. In cerulein pancreatitis the number of perfused capillaries was equally preserved in both groups. Leuko cyte adherence was reduced to 19.8% in controls and not significantly diffe rent in treated animals. Conclusion: Treatment with small-volume resuscitation reduces leukocyte adh erence, preserves micro circulation and prevents pancreatic injury in inter mediate pancreatitis. In hemorrhagic necrotizing pancreatitis, however, onl y exerted beneficial effects.