Different effects of prostacyclin and phentolamine on delivery-dependent O2 consumption and skin microcirculation after cardiac surgery.

Abstract

Inadequate tissue oxygen uptake autoregulation has been reported during the first hours after extracorporeal circulation for cardiac surgery. In the present study, we examined whether a dependence of oxygen consumption (VO2) on oxygen delivery (DO2) can be detected 24 hr after cardiac surgery using two different vasodilating agents. Cardiac output in triplicate was measured by thermodilution. Oxygen saturation of arterial and mixed venous blood was measured using a CO-oximeter. Oxygen consumption was assessed from the reverse Fick equation. In addition skin blood flow was assessed continuously by laser Doppler flowmetry. To investigate the VO2/DO2 relationship in 15 patients an increase in cardiac output and DO2 of at least 15% was achieved by systemic vasodilatation with iv prostacyclin (5-10 ng.kg-1.min-1) or phentolamine (5-10 g.kg-1.min-1). Infusion of phentolamine produced a 29 +/- 2% (mean +/- SE) increase in DO2 which was associated with a 20 +/- 6% increase in VO2. In contrast, prostacyclin produced a 22 +/- 3% increase in DO2 without change in VO2. Phentolamine did not alter skin microvascular blood flow, whereas prostacyclin increased skin microvascular blood flow by 33 +/- 3%. The results of the present study demonstrate a supply-dependency of VO2 in clinically stable patients 24 hr after cardiac surgery, suggesting the presence of an inadequate tissue O2 uptake autoregulation. The type of the vasodilator used to increase DO2 seems to play an important role in detecting such a supply-dependency of VO2, as well as changes of skin blood flow.