Microcirculatory Imaging in Cardiac Anesthesia: Ketanserin Reduces Blood Pressure But Not Perfused Capillary Density

Paul W.G. Elbers, Alaattin Ozdemir, Mat van Iterson, Eric P.A. van Dongen, Can Ince

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and α-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting. Design: An observational study. Setting: A large teaching hospital. Participants: Mechanically ventilated patients with elevated arterial blood pressure immediately after extracorporeal circulation (ECC). Intervention: An intravenous bolus of ketanserin, 0.15 mg/kg. Measurements and Main Results: Five minutes before and 10 minutes after ketanserin administration, global hemodynamic variables were recorded. In addition, the authors used SDF imaging to record video clips of the microcirculation. Analysis of these allowed for quantification of microvascular hemodynamics including determination of perfused vessel density (PVD) and microcirculatory flow index (MFI). After ketanserin administration, there was a significant reduction in systolic arterial blood pressure (129 ± 9 to 100 ± 15 mmHg, p = 0.0001). At the level of the microcirculation, the mean MFI did not change significantly for small (diameter <20 μm, 2.79 [interquartile range, 1.38-3] to 2.38 [1.88-2.75], p = 0.62) or large (diameter >20 μm, 2.83 [1.4-3] to 2.67 [0.35-2.84] p = 1.0) vessels. There was a significant increase in mean PVD for large vessels (1.23 ± 0.63 to 1.70 ± 79 mm-1, p = 0.017) but not for small vessels (5.59 ± 2.60 to 5.87 ± 1.22 mm-1, p = 0.72) where red blood cell flow was maintained. Conclusions: SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation.

Original languageEnglish
Pages (from-to)95-101
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume23
Issue number1
DOIs
Publication statusPublished - 1 Feb 2009

Cite this

@article{b43ec7b9e2ec42e99430b8bc0daea51d,
title = "Microcirculatory Imaging in Cardiac Anesthesia: Ketanserin Reduces Blood Pressure But Not Perfused Capillary Density",
abstract = "Objectives: It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and α-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting. Design: An observational study. Setting: A large teaching hospital. Participants: Mechanically ventilated patients with elevated arterial blood pressure immediately after extracorporeal circulation (ECC). Intervention: An intravenous bolus of ketanserin, 0.15 mg/kg. Measurements and Main Results: Five minutes before and 10 minutes after ketanserin administration, global hemodynamic variables were recorded. In addition, the authors used SDF imaging to record video clips of the microcirculation. Analysis of these allowed for quantification of microvascular hemodynamics including determination of perfused vessel density (PVD) and microcirculatory flow index (MFI). After ketanserin administration, there was a significant reduction in systolic arterial blood pressure (129 ± 9 to 100 ± 15 mmHg, p = 0.0001). At the level of the microcirculation, the mean MFI did not change significantly for small (diameter <20 μm, 2.79 [interquartile range, 1.38-3] to 2.38 [1.88-2.75], p = 0.62) or large (diameter >20 μm, 2.83 [1.4-3] to 2.67 [0.35-2.84] p = 1.0) vessels. There was a significant increase in mean PVD for large vessels (1.23 ± 0.63 to 1.70 ± 79 mm-1, p = 0.017) but not for small vessels (5.59 ± 2.60 to 5.87 ± 1.22 mm-1, p = 0.72) where red blood cell flow was maintained. Conclusions: SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation.",
keywords = "capillary density, cardiac surgery, extracorporeal circulation, hypertension, intensive care, ketanserin, microcirculation, sidestream dark field",
author = "Elbers, {Paul W.G.} and Alaattin Ozdemir and {van Iterson}, Mat and {van Dongen}, {Eric P.A.} and Can Ince",
year = "2009",
month = "2",
day = "1",
doi = "10.1053/j.jvca.2008.09.013",
language = "English",
volume = "23",
pages = "95--101",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
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}

Microcirculatory Imaging in Cardiac Anesthesia : Ketanserin Reduces Blood Pressure But Not Perfused Capillary Density. / Elbers, Paul W.G.; Ozdemir, Alaattin; van Iterson, Mat; van Dongen, Eric P.A.; Ince, Can.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 23, No. 1, 01.02.2009, p. 95-101.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Microcirculatory Imaging in Cardiac Anesthesia

T2 - Ketanserin Reduces Blood Pressure But Not Perfused Capillary Density

AU - Elbers, Paul W.G.

AU - Ozdemir, Alaattin

AU - van Iterson, Mat

AU - van Dongen, Eric P.A.

AU - Ince, Can

PY - 2009/2/1

Y1 - 2009/2/1

N2 - Objectives: It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and α-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting. Design: An observational study. Setting: A large teaching hospital. Participants: Mechanically ventilated patients with elevated arterial blood pressure immediately after extracorporeal circulation (ECC). Intervention: An intravenous bolus of ketanserin, 0.15 mg/kg. Measurements and Main Results: Five minutes before and 10 minutes after ketanserin administration, global hemodynamic variables were recorded. In addition, the authors used SDF imaging to record video clips of the microcirculation. Analysis of these allowed for quantification of microvascular hemodynamics including determination of perfused vessel density (PVD) and microcirculatory flow index (MFI). After ketanserin administration, there was a significant reduction in systolic arterial blood pressure (129 ± 9 to 100 ± 15 mmHg, p = 0.0001). At the level of the microcirculation, the mean MFI did not change significantly for small (diameter <20 μm, 2.79 [interquartile range, 1.38-3] to 2.38 [1.88-2.75], p = 0.62) or large (diameter >20 μm, 2.83 [1.4-3] to 2.67 [0.35-2.84] p = 1.0) vessels. There was a significant increase in mean PVD for large vessels (1.23 ± 0.63 to 1.70 ± 79 mm-1, p = 0.017) but not for small vessels (5.59 ± 2.60 to 5.87 ± 1.22 mm-1, p = 0.72) where red blood cell flow was maintained. Conclusions: SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation.

AB - Objectives: It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and α-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting. Design: An observational study. Setting: A large teaching hospital. Participants: Mechanically ventilated patients with elevated arterial blood pressure immediately after extracorporeal circulation (ECC). Intervention: An intravenous bolus of ketanserin, 0.15 mg/kg. Measurements and Main Results: Five minutes before and 10 minutes after ketanserin administration, global hemodynamic variables were recorded. In addition, the authors used SDF imaging to record video clips of the microcirculation. Analysis of these allowed for quantification of microvascular hemodynamics including determination of perfused vessel density (PVD) and microcirculatory flow index (MFI). After ketanserin administration, there was a significant reduction in systolic arterial blood pressure (129 ± 9 to 100 ± 15 mmHg, p = 0.0001). At the level of the microcirculation, the mean MFI did not change significantly for small (diameter <20 μm, 2.79 [interquartile range, 1.38-3] to 2.38 [1.88-2.75], p = 0.62) or large (diameter >20 μm, 2.83 [1.4-3] to 2.67 [0.35-2.84] p = 1.0) vessels. There was a significant increase in mean PVD for large vessels (1.23 ± 0.63 to 1.70 ± 79 mm-1, p = 0.017) but not for small vessels (5.59 ± 2.60 to 5.87 ± 1.22 mm-1, p = 0.72) where red blood cell flow was maintained. Conclusions: SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation.

KW - capillary density

KW - cardiac surgery

KW - extracorporeal circulation

KW - hypertension

KW - intensive care

KW - ketanserin

KW - microcirculation

KW - sidestream dark field

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U2 - 10.1053/j.jvca.2008.09.013

DO - 10.1053/j.jvca.2008.09.013

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EP - 101

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

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