Gut endotoxin restriction improves postoperative hemodynamics in the bile duct-ligated rat

Background: Postoperative hemodynamic disturbances in obstructive jaundice are associated with complications such as shock and renal failure. Gut-derived endotoxemia may underlie these complications. Recently, we have shown that cholestyramine treatment prevents gut-derived endotoxemia in bile duct-ligated (BDL) rats (Houdijk APJ, Boermeester MA, Wesdorp RIG, Hack CE, van Leeuwen PAM: Tumor necrosis factor unresponsiveness following surgery in bile duct-ligated rats. Am J Physiol 271: G980-G986, 1996). Methods: The effect of cholestyramine on systemic hemodynamics and organ blood flows after a laparotomy was studied in 2 wk BDL rats using radioactive microspheres, Results: Compared with sham-operated rats, postoperative BDL rats had 1) lower blood pressure (p <.05) and heart rate (p < .001) with higher cardiac output (p <.05), 2) lower splanchnic blood flow (p <.05), 3) lower renal blood flow (p <.01), and 4) higher splanchnic organ and renal-vascular resistances. Cholestyramine treatment in BDL rats prevented the postoperative decrease in blood pressure by increasing cardiac output (p <.01). In addition, cholestyramine maintained splanchnic blood flow at sham levels (p <.05). Furthermore, cholestyramine also prevented the fall in renal blood flow after surgery in BDL rats. Conclusion: Gut endotoxin restriction using cholestyramine treatment maintained normal blood pressure, improved splanchnic blood flow, and completely prevented the fall in renal blood flow in BDL rats. Reducing the gut load of endotoxin in patients with obstructive jaundice scheduled for abdominal surgery may prevent postoperative hemodynamic complications.