The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy: An observational study

BACKGROUND: It is not clear whether moderate intraoperative blood loss and norepinephrine used to restore the macrocirculation impair the microcirculation and affect microcirculation/macrocirculation coherence.

OBJECTIVE: We sought to investigate the effect of moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension on the sublingual microcirculation.

DESIGN: Prospective observational study.

SETTING: University Medical Center Hamburg-Eppendorf, Hamburg, Germany, from November 2018 to March 2019.

PATIENTS: Thirty patients scheduled for open radical prostatectomy and 29 healthy volunteer blood donors.

INTERVENTION: Simultaneous assessment of the macrocirculation using a noninvasive finger-cuff method and the sublingual microcirculation using vital microscopy.

MAIN OUTCOME MEASURES: The main outcome measures were changes in the sublingual microcirculation caused by moderate intraoperative blood loss and norepinephrine therapy.

RESULTS: General anaesthesia decreased median [IQR] mean arterial pressure from 100 [90 to 104] to 79 [69 to 87] mmHg (P < 0.001), median heart rate from 69 [63 to 79] to 53 [44 to 62] beats per minute (P < 0.001), median cardiac index from 2.67 [2.42 to 3.17] to 2.09 [1.74 to 2.49] l min-1 m-2 (P < 0.001), and median microvascular flow index from 2.75 [2.66 to 2.85] to 2.50 [2.35 to 2.63] (P = 0.001). A median blood loss of 600 [438 to 913] ml until the time of prostate removal and norepinephrine therapy to treat intraoperative hypotension had no detrimental effect on the sublingual microcirculation: There were no clinically important changes in the microvascular flow index, the proportion of perfused vessels, the total vessel density, and the perfused vessel density. Blood donation resulted in no clinically important changes in any of the macrocirculatory or microcirculatory variables.

CONCLUSION: Moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension have no detrimental effect on the sublingual microcirculation and the coherence between the macrocirculation and microcirculation in patients having open radical prostatectomy.