Influence of intraoperative vasopressor use on indocyanine green fluorescence angiography: first evaluation in an experimental model

Michael Kugler,Eric Noll,Sophie Diemunsch,Tim Pruimboom,Laurents P. S. Stassen,Mahdi Al-Taher,Rutger M. Schols,Alexandre Hostettler,Jacques Marescaux,René R. W. J. van der Hulst,Nariaki Okamoto,Nicole D. Bouvy,Michele Diana

doi:10.1038/s41598-021-89223-2

Abstract

Intraoperative indocyanine green (ICG) fluorescence angiography has gained popularity and acceptance in many surgical fields for the real-time assessment of tissue perfusion. Although vasopressors have the potential to preclude an accurate assessment of tissue perfusion, there is a lack of literature with regards to its effect on ICG fluorescence angiography. An experimental porcine model was used to expose the small bowel for quantitative tissue perfusion assessment. Three increasing doses of norepinephrine infusion (0.1, 0.5, and 1.0 µg/kg/min) were administered intravenously over a 25-min interval. Time-to-peak fluorescence intensity (TTP) was the primary outcome. Secondary outcomes included absolute fluorescence intensity and local capillary lactate (LCL) levels. Five large pigs (mean weight: 40.3 ± 4.24 kg) were included. There was no significant difference in mean TTP (in seconds) at baseline (4.23) as compared to the second (3.90), third (4.41), fourth (4.60), and fifth ICG assessment (5.99). As a result of ICG accumulation, the mean and the maximum absolute fluorescence intensity were significantly different as compared to the baseline assessment. There was no significant difference in LCL levels (in mmol/L) at baseline (0.74) as compared to the second (0.82), third (0.64), fourth (0.60), and fifth assessment (0.62). Increasing doses of norepinephrine infusion have no significant influence on bowel perfusion using ICG fluorescence angiography.

Highlights

Intraoperative indocyanine green (ICG) fluorescence angiography has gained popularity and acceptance in many surgical fields for the real-time assessment of tissue perfusion
There were a few previous studies which evaluated the effect of vasopressors on free flap perfusion using ICGA, this is the first study evaluating the influence of increasing doses of intraoperative vasopressor use on ICG fluorescence angiography in a standardized porcine m odel[24,25]
An adequate intraoperative assessment of bowel perfusion is mandatory in order to prevent anastomotic leakage

Summary

Introduction

Intraoperative indocyanine green (ICG) fluorescence angiography has gained popularity and acceptance in many surgical fields for the real-time assessment of tissue perfusion. Fluorescence angiography, using indocyanine green (ICG) as a contrast agent, is increasingly applied by surgeons during surgical procedures, facilitating intraoperative decision-making This imaging technique is fast (i.e., a matter of seconds to minutes), safe, and easy to perform, and multiple assessments can be performed during a single procedure[1]. These subjective signs did not allow to evaluate microperfusion and were found to be unreliable since the accuracy of AL prediction by surgeons was low[7,8,9] For this reason, ICG fluorescence angiography was proposed as an objective imaging technique which allows for the real-time assessment of bowel perfusion. FLER analyses were found to be correlated with local capillary lactate (LCL) levels, in the experimental[10] and clinical setting[15]

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