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Effects of intraoperative angiotensin-converting enzyme inhibition by quinaprilat on gastric mucosal blood flow during cardiopulmonary bypass in humans

M. Müller1, M. Kwapisz1, S. Klemm1, H. Maxeiner1, H. Akintürk2, K. Valeske2
University Hospital Gießen and Marburg GmbH, Campus Gießen: 1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy; 2Department of Cardiovascular Surgery
[Applied Cardiopulmonary Pathophysiology 14: 43-50, 2010]


Laser Doppler flow (LDF) assessment and regional carbon dioxide measurements by air tonometry were performed to estimate the changes in gastric mucosal blood flow after angiotensin-converting enzyme (ACE) inhibition in patients undergoing cardiopulmonary bypass (CPB).
Patients scheduled for elective CABG were prospectively assigned to group A (quinaprilat 0.02 mg/kg, n = 10), group B (quinaprilat 0.04 mg/kg, n = 10), or group C (control, n = 10). Baseline values were measured after induction of anesthesia (T0) and repeated during steady state CPB (T1). Thereafter either quinaprilat, a non-sulphydryl ACE inhibitor, (group A and B) or saline solution (group C) were given as an intravenous bolus. The LDF measurements were performed after 5 (T2), 10 (T3), 15 (T4) minutes during CPB as well as 5 minutes after weaning off CPB (T5) and at the end of surgery (T6). The tonometric measurements were repeated at T4, T5 and T6.
During hypothermic CPB LDF decreased in all groups. In group B only, LDF returned to baseline after application of quinaprilat. At the end of surgery (T6) LDF returned to baseline in group A and C, too. In group B LDF was significantly higher at T3, T4, T5 and T6 compared to control (p < 0.05). No difference between the groups as well as over the time course could be seen with regard to carbon dioxide tension of the gastric mucosa.
The results of the LDF measurements suggests a selective increase in gastric mucosal blood flow after ACE inhibition.

Key words: laser doppler flowmetry, tonometry, angiotensin-converting enzyme inhibition, quinaprilat, cardiac surgery, cardiopulmonary bypass, gastric mucosal blood flow

Address for corresponding:
PD Dr. Matthias Müller, Department of Anaesthesiology Intensive Care Medicine and Pain Therapy, University Hospital Gießen and Marburg GmbH, Campus Gießen, Rudolf-Buchheim-Str. 7, 35392 Gießen, Germany
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