Continuous assessment of colonic perfusion during abdominal aortic reconstruction using a modified Paratrend 7^™

Background

Colonic ischaemia may initiate multiple organ dysfunction syndrome following abdominal aortic reconstruction. Most methods available to detect colonic hypoperfusion are not ideal for continuous intraoperative and postoperative monitoring.

Objective

Prospective evaluation of the use of a modified intra-arterial fiberoptic probe (Paratrend 7^™) for continuous perioperative monitoring of colonic luminal pH, P_CO2 and P_O2 in patients undergoing abdominal aortic reconstruction.

Study design

Fourteen consecutive patients scheduled for infrarenal abdominal aortic reconstruction were recruited. Preoperative bowel preparation was partially performed in the first six patients and completely performed in the last eight patients. Under general anaesthetic, a modified Paratrend 7^™ probe was inserted transanally to the rectosigmoid junction. Continuous intraoperative analysis was compared to intermittent intraoperative inferior mesenteric vein (IMV) sampling for pH, P_CO2 and p_O2), was observed on aortic cross clamping and declamping. The 95% limits of agreement with IMV pH, in patients with complete bowel preparation were 0.16 and -0.1 for the calculated intramucosal pH and 0.72 and -0.48 for the luminal pH. The estimated bias for the calculated pHi was -0.03. Results were directly affected by the condition of bowel preparation

Conclusion

The modified Paratrend 7^™ effectively detects changes in colonic perfusion during abdominal aortic reconstruction. However, complete bowel preparation is essential and modifications may be required to increase its precision.