Influence of prostaglandin E1 on tissue ischemia during surgical repair of the abdominal aorta

Objective: To evaluate tissue protection by PGE(1) during leg ischemia in patients undergoing aortic surgery. Design: Randomized, controlled prospective clinical trial. Setting: Single university hospital. Participants: 19 consecutive patients undergoing abdominal aortic aneurysm repair. Interventions: Patients received infusions of 30 ng/kg/min of PGE(1) or saline. Measurements and Main Results: Hemodynamic variables. lactate, creatine phosphokinase, and thromboxane B-2 (TXB(2)) were measured. In the control group, the decrease in cardiac index (CI) after aortic cross-clamping (AXC) persisted until unclamping together with a decrease in femoral venous O-2 content (CfvO2). In the PGE(1) group, CI returned to baseline with a trend toward greater CfvO2 levels. During reperfusion in the PGE(1) group, O-2 consumption and lactate levels exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB(2), which was not altered by surgery or by PGE(1) infusion. Conclusions: Intraoperative PGE(1) treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxygen utilization in a manner that overwhelms any possible protective effect. (C) 1996 by W.B. Saunders Company