scholarly journals Hepatopulmonary Syndrome. Review

2021 ◽  
Vol 6 (3) ◽  
pp. 45-52
Author(s):  
V. V. Potii ◽  
◽  
V. T. Kiriienko ◽  
E. I. Glukhova ◽  
O. S. Kunickaya ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatopulmonary Syndrome ◽  
Gas Analysis ◽  
Arterial Oxygen ◽  
Common Symptom ◽  
Portopulmonary Hypertension ◽  
Oxygen Gradient ◽  
Arterial Blood ◽  
Intrapulmonary Shunting

Liver cirrhosis is often accompanied by complications from the pulmonary system. These include hydrothorax, portopulmonary hypertension and hepatopulmonary syndrome. Hepatic hydrothorax affects about 6-10% of patients with end-stage disease, which results in the passage of ascetic fluid into the pleural space through diaphragm defects. The common cause of the hepatopulmonary syndrome and portopulmonary hypertension is portal hypertension and portosystemic shunting, indicating that vasoactive and angiogenetic factors originating from the liver normally control the pulmonary circulation. Portopulmonary hypertension is like pulmonary arterial hypertension, which develops against the background of portal hypertension as a result of chronic liver disease or without other causes of increased pressure in the pulmonary vessels. The prevalence of portopulmonary hypertension ranges from 2% to 8.5% among patients with portal hypertension and is associated with a poor prognosis. Hepatopulmonary syndrome is characterized by intrapulmonary dilatation of microvessels, which causes intrapulmonary shunting and leads to impaired gas exchange in liver diseases, and is associated with a decrease in the quality and duration of life in patients with cirrhosis. Nitric oxide overproduction and angiogenesis seem to be the hallmarks of a complicated pathogenetic mechanism, leading to intrapulmonary shunting and ventilation-perfusion mismatch. A classification of hepatopulmonary syndrome according to the severity of hypoxemia has been suggested. Hepatopulmonary syndrome includes a triad: hepatic dysfunction and / or portal hypertension, dilatation of intrapulmonary vessels, and increased alveolar-arterial oxygen gradient. The prevalence of hepatopulmonary syndrome varies depending on the study groups from 5% to 30%. The most common symptom of the complication is shortness of breath, but in most cases, hepatopulmonary syndrome is asymptomatic. A decrease in oxygen saturation less than 96% corresponds to a decrease in PaO2<70 mm Hg and testifies to the possible development of hepatopulmonary syndrome. In the case of a positive screening, the patient should undergo arterial blood gas analysis, which helps to determine PaO2 and alveolar to arterial oxygen gradient. Conclusion. Contrast-enhanced echocardiography with agitated saline is the gold standard in the diagnosis of intrapulmonary dilatation. The only effective treatment for hepatopulmonary syndrome is liver transplantation. Complete recovery of hepatopulmonary syndrome after liver transplantation is observed within a year in most patients with cirrhosis and hepatopulmonary syndrome

scholarly journals The Role of Garlic in Hepatopulmonary Syndrome: A Randomized Controlled Trial

2010 ◽  
Vol 24 (3) ◽  
pp. 183-188 ◽  
Author(s):  
Binay K De ◽  
Deep Dutta ◽  
Subrata K Pal ◽  
Subhabrata Gangopadhyay ◽  
Sumanta Das Baksi ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Placebo Group ◽  
Controlled Trial ◽  
Hepatopulmonary Syndrome ◽  
Arterial Oxygen ◽  
Nitric Oxide Production ◽  
Arterial Blood Gas ◽  
Oxygen Gradient ◽  
Oxide Production ◽  
Arterial Blood

BACKGROUND: Increased nitric oxide production in cirrhosis has been commonly implicated in the genesis of hepatopulmonary syndrome (HPS). Initial studies suggested that garlic, a constituent of the daily diet, may have a role in the treatment of HPS by altering nitric oxide production.OBJECTIVE: To evaluate the effects of oral garlic supplementation on arterial blood gas parameters, and overall morbidity and mortality in patients with HPS.METHODS: Twenty-one and 20 HPS patients were randomly assigned to receive either oral garlic supplementation or placebo, respectively, and were evaluated monthly over a period of nine to 18 months.RESULTS: After nine months, garlic supplementation was associated with a 24.66% increase in baseline arterial oxygen levels (83.05 mmHg versus 66.62 mmHg; P<0.001), compared with only a 7.37% increase (68.75 mmHg versus 64.05 mmHg; P=0.02) among subjects in the placebo group. There was also a 28.35% decrease in alveolar-arterial oxygen gradient (21.35 mmHg versus 29.77 mmHg; P<0.001) among patients with HPS who received garlic, in contrast with only a 10.73% decrease (29.11 mmHg versus 32.61 mmHg; P=0.12) among those in the placebo group. After nine months, the arterial oxygen level was significantly higher (83.05 mmHg versus 68.75 mmHg; P<0.001) and the alveolar-arterial oxygen gradient was significantly lower (21.35 mmHg versus 29.11 mmHg; P<0.001) among patients receiving garlic compared with those receiving placebo. Reversal of HPS was observed in 14 of 21 patients (66.67%) on garlic supplementation (intent-to-treat analysis) and in one of 20 patients (5%) on placebo. Two of 21 patients undergoing garlic supplementation died during follow-up in contrast to seven of 20 patients who were on placebo.CONCLUSIONS: Garlic supplementation may be beneficial in patients with HPS for the reversal of intrapulmonary shunts as well as reducing hypoxemia and mortality.

scholarly journals Effects of Caffeine Treatment on Hepatopulmonary Syndrome in Biliary Cirrhotic Rats

2019 ◽  
Vol 20 (7) ◽  
pp. 1566
Author(s):  
Ching-Chih Chang ◽  
Chiao-Lin Chuang ◽  
Ming-Hung Tsai ◽  
I.-Fang Hsin ◽  
Shao-Jung Hsu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Liver Fibrosis ◽  
Portal Pressure ◽  
Hepatopulmonary Syndrome ◽  
Gas Analysis ◽  
Common Bile Duct Ligation ◽  
Arterial Blood ◽  
Duct Ligation ◽  
Intrapulmonary Shunting ◽  
Protein Expressions

Hepatopulmonary syndrome (HPS) is a lethal complication of cirrhosis characterized by hypoxia and overt intrapulmonary shunting. In this study, we investigated the effect of caffeine in rats with common bile duct ligation (CBDL)-induced liver cirrhosis and HPS. CBDL rats were randomly allocated to receive caffeine or vehicle for 14 days. On the 28th day after CBDL, mortality rate, hemodynamics, liver, and renal biochemistry parameters and arterial blood gas analysis were evaluated. Lung and liver were dissected for the evaluation of inflammation, angiogenesis and protein expressions. In another series with parallel groups, the intrapulmonary shunting was determined. Caffeine significantly reduced portal pressure (caffeine vs. control: 10.0 ± 3.7 vs. 17.0 ± 8.1 mmHg, p < 0.05) in CBDL rats. The mortality rate, mean arterial pressure, biochemistry data and hypoxia were similar between caffeine-treated and control groups. Caffeine alleviated liver fibrosis and intrahepatic angiogenesis but intrapulmonary inflammation and angiogenesis were not ameliorated. The hepatic VEGF/Rho-A protein expressions were down-regulated but the pulmonary inflammation- and angiogenesis-related protein expressions were not significantly altered by caffeine. Caffeine did not reduce the intrapulmonary shunting, either. Caffeine has been shown to significantly improve liver fibrosis, intrahepatic angiogenesis and portal hypertension in cirrhotic rats, however, it does not ameliorate HPS.

Impact of Hepatopulmonary Syndrome in Liver Transplantation Candidates and the Role of Angiogenesis

2021 ◽  
pp. 2102304
Author(s):  
Steven M. Kawut ◽  
Michael J. Krowka ◽  
Kimberly A. Forde ◽  
Nadine Al-Naamani ◽  
Karen L. Krok ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Vascular Complications ◽  
Hepatopulmonary Syndrome ◽  
Functional Class ◽  
Hazard Ratio ◽  
Arterial Oxygen ◽  
Risk Of Death ◽  
Increased Risk

Hepatopulmonary syndrome affects 10–30% of patients with cirrhosis and portal hypertension. We evaluated the serum angiogenic profile of hepatopulmonary syndrome and assessed the clinical impact of hepatopulmonary syndrome in patients evaluated for liver transplantation.The Pulmonary Vascular Complications of Liver Disease 2 study was a multicentre, prospective cohort study of adults undergoing their first liver transplantation evaluation. Hepatopulmonary syndrome was defined as an alveolar-arterial oxygen gradient ≥15 mmHg (≥20 mmHg if age >64 years), positive contrast-enhanced transthoracic echocardiography, and absence of lung disease.We included 85 patients with hepatopulmonary syndrome and 146 patients without hepatopulmonary syndrome. Patients with hepatopulmonary syndrome had more complications of portal hypertension and slightly higher Model for End-stage Liver Disease-Na score compared to those without hepatopulmonary syndrome (median [interquartile range] 15 [12, 19] versus 14 [10, 17], p=0.006). Hepatopulmonary syndrome patients had significantly lower six minute walk distance and worse functional class. Hepatopulmonary syndrome patients had higher circulating angiopoietin-2, Tie2, tenascin-C, c-kit, VCAM-1, and von Willebrand factor levels, and lower E-selectin levels. Patients with hepatopulmonary syndrome had an increased risk of death (hazard ratio 1.80 [1.03–3.16], p=0.04) which persisted despite adjustment for covariates (hazard ratio 1.79 [1.02–3.15], p=0.04). This association did not vary based on levels of oxygenation reflecting the severity of hepatopulmonary syndrome.Hepatopulmonary syndrome was associated with a profile of abnormal systemic angiogenesis, worse exercise and functional capacity, and an overall increased risk of death.

scholarly journals Predictors of Intensive Care Unit admission in patients with coronavirus disease 2019 (COVID-19)

2020 ◽  
Vol 90 (3) ◽  
Author(s):  
Maria Viviana Carlino ◽  
Natja Valenti ◽  
Flavio Cesaro ◽  
Anita Costanzo ◽  
Giovanna Cristiano ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Arterial Oxygen ◽  
Blood Gas ◽  
Partial Pressure Of Oxygen ◽  
Oxygen Gradient ◽  
Icu Admission ◽  
Arterial Blood

Italy is currently experiencing an epidemic of coronavirus disease 2019 (Covid-19). Aim of our study is to identify the best predictors of Intensive Care Unit (ICU) admission in patients with Covid-19. We examined 28 patients admitted to the Emergency Department (ED) and subsequently confirmed as cases of Covid-19. Patients received, at the admission to the ED, a diagnostic work-up including: patient history, clinical examination, an arterial blood gas analysis (whenever possible performed on room air), laboratory blood tests, including serum concentrations of interleukin-6 (IL-6), lung ultrasound examination and a computed tomography (CT) scan of the thorax. For each patient, as gas exchange index through the alveolocapillary membrane, we determined the alveolar-arterial oxygen gradient (AaDO⁠2) and the alveolar-arterial oxygen gradient augmentation (AaDO⁠2 augmentation). For each patient, as measurement of hypoxemia, we determined oxygen saturation (SpO2), partial pressure of oxygen in arterial blood (PaO⁠2), PaO⁠2 deficit and the ratio between arterial partial pressure of oxygen by blood gas analysis and fraction of inspired oxygen (P/F). Patients were assigned to ICU Group or to Non-ICU Group basing on the decision to intubate. Areas under the curve (AUC) and receiver operating characteristic (ROC) curve were used to compare the performance of each test in relation to prediction of ICU admission. Comparing patients of ICU Group (10 patients) with patients of Non-ICU Group (18 patients), we found that the first were older, they had more frequently a medical history of malignancy and they were more frequently admitted to ED for dyspnea. Patients of ICU Group had lower oxygen saturation, PaO⁠2, P/F and higher heart rate, respiratory rate, AaDO⁠2, AaDO⁠2 augmentation and lactate than patients of Non-ICU Group. ROC curves demonstrate that age, heart rate, respiratory rate, dyspnea, lactate, AaDO2, AaDO2 augmentation, white blood cell count, neutrophil count and percentage, fibrinogen, C-reactive protein, lactate dehydrogenase, glucose level, international normalized ratio (INR), blood urea and IL-6 are useful predictors of ICU admission. We identified several predictors of ICU admission in patients with Covid-19. They can act as fast tools for the early identification and timely treatment of critical cases since their arrival in the ED.

scholarly journals The hepatopulmonary syndrome

2014 ◽  
Vol 27 (2) ◽  
pp. 145-147 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wellington ANDRAUS ◽  
Rafael Soares PINHEIRO ◽  
Liliana DUCATTI ◽  
Luciana BP HADDAD ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Clinical Manifestation ◽  
Therapeutic Option ◽  
Hepatopulmonary Syndrome ◽  
Supplemental Oxygen ◽  
Vascular Complication ◽  
Low Flow ◽  
Arterial Oxygen ◽  
Effective Therapeutic Option

INTRODUCTION: The hepatopulmonary syndrome has been acknowledged as an important vascular complication in lungs developing systemic hypoxemia in patients with cirrhosis and portal hypertension. Is formed by arterial oxygenation abnormalities induced from intrapulmonary vascular dilatations with liver disease. It is present in 4-32% of patients with cirrhosis. It increases mortality in the setting of cirrhosis and may influence the frequency and severity. Initially the hypoxemia responds to low-flow supplemental oxygen, but over time, the need for oxygen supplementation is necessary. The liver transplantation is the only effective therapeutic option for its resolution. AIM: To update clinical manifestation, diagnosis and treatment of this entity. METHOD: A literature review was performed on management of hepatopulmonary syndrome. The electronic search was held of the Medline-PubMed, in English crossing the headings "hepatopulmonary syndrome", "liver transplantation" and "surgery". The search was completed in September 2013. RESULTS: Hepatopulmonary syndrome is classically defined by a widened alveolar-arterial oxygen gradient (AaPO2) on room air (>15 mmHg, or >20 mmHg in patients >64 years of age) with or without hypoxemia resulting from intrapulmonary vasodilatation in the presence of hepatic dysfunction or portal hypertension. Clinical manifestation, diagnosis, classification, treatments and outcomes are varied. CONCLUSION: The severity of hepatopulmonary syndrome is an important survival predictor and determine the improvement, the time and risks for liver transplantation. The liver transplantation still remains the only effective therapeutic.

Portopulmonary hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2534-2537
Author(s):  
Olivier Sitbon ◽  
Laurent Savale
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatopulmonary Syndrome ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Channel Blockers ◽  
Portopulmonary Hypertension ◽  
Right Heart ◽  
Pulmonary Haemodynamics

Portal hypertension, with or without liver disease, may have major consequences on pulmonary circulation due to complex pathophysiological interactions between the liver and the lungs. There are two distinct pulmonary vascular disorders associated with portal hypertension: hepatopulmonary syndrome, characterized by gas exchange impairment due to intrapulmonary shunts, and portopulmonary hypertension (PoPH), which is a particular form of pulmonary arterial hypertension (PAH). PoPH is a severe complication of portal hypertension, affecting functional status, exercise capacity, and survival of affected patients. Detection of PoPH by transthoracic echocardiography must be performed in symptomatic patients and in all candidates for liver transplantation. Right heart catheterization is mandatory to confirm the diagnosis of PoPH and exclude other causes of pulmonary artery pressure elevation, including fluid overload and high cardiac output, that are common features in portal hypertension. The management of PoPH is similar to that of other forms of PAH although very few trials have investigated the effects of PAH-targeted therapies in this particular indication. Anticoagulants and calcium channel blockers are usually not indicated in this setting. PAH-targeted medications can be used to improve pulmonary haemodynamics and bridge patients with severe PoPH to liver transplantation. However, the impact of liver transplantation on outcomes of patients with PoPH remains unpredictable. While uncontrolled PoPH is associated with a higher risk of perioperative right heart failure and death, stabilization, improvement, or normalization of pulmonary haemodynamics after liver transplantation seem to be achievable goals in selected patients with PoPH.

scholarly journals Triagem da síndrome hepatopulmonar: oximetria de pulso ou gasometria arterial?/ Hepatopulmonary syndrome screening: pulse oximetry or arterial gasometry?

2019 ◽  
Vol 64 (3) ◽  
pp. 184
Author(s):  
Cláudia Debona Mocelin ◽  
Marina Ribeiro Rocha ◽  
Mariana Poltronieri Pacheco
Keyword(s):  
Liver Transplantation ◽  
Pulse Oximetry ◽  
Hepatopulmonary Syndrome ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Cirrhotic Patients

Objetivo: Avaliar se a realização rotineira da gasometria arterial em todos os pacientes cirróticos pode ser substituída pela oximetria de pulso isolada para a triagem de SHP. Material e métodos: Estudo observacional, individuado e transversal do tipo inquérito, por meio da análise dos prontuários dos pacientes do ambulatório de gastroenterologia e hepatologia do Hospital Santa Casa de Misericórdia de Vitória, localizado na cidade de Vitória - ES, e por meio da análise da gasometria arterial destes pacientes. Como critérios para o diagnóstico de cirrose, foram utilizados a história clínica, o exame físico, a análise laboratorial e pelo menos um exame de imagem.  Resultados: A amostra teve 75,4% de homens, com etiologia alcoólica sendo mais prevalente (53%). A idade média foi de 54 anos, não tendo correlação com a PaO2 (p = 0,754) e com a AaO2 (p = 0,574). A prevalência de pacientes Child A foi de 88,2% e Child B de 11,8%. A maioria (88,2%) dos pacientes apresentaram gradiente AaO2 ≥ 20 mmHg, compatível com critério diagnóstico gasométrico de SHP. Discussão: Não foi observada correlação significativa entre a oxigenação sanguínea medida pela gasometria arterial e pela oximetria de pulso. Pacientes com PaO2 < 60 mmHg apresentaram SatO2 mínima de 93% e mediana de 97%, DP 2,2, comparado com mínima de 85% e mediana de 87%, DP 3,9,  nos pacientes com níveis ≥ 60 mmHg (p = 0,827). Portanto, nota-se que a SatO2 medida pela oximetria de pulso não é um bom parâmetro para triagem de SHP nos pacientes cirróticos. Conclusões: A gasometria arterial é indispensável em todos os pacientes cirróticos para triagem da Síndrome Hepatopulmonar, independente da classe funcional, não podendo ser substituída pela oximetria de pulso. Tal conduta visa acelerar o diagnóstico dessa síndrome, considerando a inexistência de correlação entre os critérios diagnósticos gasométricos já estabelecidos e os valores obtidos na oximetria de pulso e no escore Child-Pugh. Tendo em vista que a Síndrome Hepatopulmonar é uma indicação de transplante hepático, seu diagnóstico precoce pode adiantar o processo, melhorando a resposta terapêutica e a sobrevida dos pacientes.Descritores: Síndrome hepatopulmonar, Cirrose hepática, Transplante de fígado, Oximetria, GasometriaABSTRACTObjective: To evaluate whether routine arterial blood gas analysis in all cirrhotic patients can be replaced by isolated pulse oximetry for HPS screening. Material and methods: Observational, individualized and cross-sectional study, by analyzing the medical records of patients from the gastroenterology and hepatology outpatient clinic of the Santa Casa de Misericórdia de Vitória Hospital, located in the city of Vitória - ES, and by analyzing the laboratory results of the arterial blood gases of these patients. The criteria for the diagnosis of cirrhosis were clinical history, physical examination, laboratory analysis and at least one imaging exam. Results: A total of 75.4% of the sample consisted of males, with alcoholic etiology being more prevalent (53%). The mean age was 54 years, with no correlation with PaO 2 (p = 0.754) and AaO 2 (p = 0.574). The prevalence of Child A patients was 88.2% and of Child B was 11.8%. The majority (88.2%) of the patients presented a AaO2 gradient ≥ 20 mmHg, compatible with HPS gasometric diagnostic criteria.  Discussion: No significant correlation was observed between blood oxygenation as measured by arterial blood gas and pulse oximetry. Patients with PaO2 <60 mmHg had a minimum SatO2 of 93% and a median of 97%, SD 2.2, compared with a minimum of 85% and a median of 87%, SD 3.9, in patients with levels ≥ 60 mmHg (p = 0.827). Therefore, it is noted that SatO2 measured by pulse oximetry is not a good parameter for screening for SHP in cirrhotic patients. Conclusion: Arterial blood gas analysis is indispensable in all cirrhotic patients in screening for Hepatopulmonary Syndrome, regardless of functional class, and cannot be replaced by pulse oximetry. Such conduct aims to accelerate the diagnosis of this syndrome, considering the inexistence of correlation between the already established gasometric diagnostic criteria and the values obtained in pulse oximetry and Child- Pugh score. Since the existence of Hepatopulmonary Syndrome is an indication for liver transplantation, early diagnosis may accelerate the process, improving therapeutic response and survival in patients.Keywords: Hepatopulmonary syndrome, Liver cirrhosisc Liver transplantation, Oximetry, Gasometry

scholarly journals Sequestro Leucocitário de Oxigénio

2016 ◽  
Vol 29 (5) ◽  
pp. 343
Author(s):  
Miguel Pinto da Costa ◽  
Henrique Pimenta Coelho
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Arterial Oxygen Saturation ◽  
Gas Analysis ◽  
Lymphocytic Leukemia ◽  
Red Blood Cell Transfusion ◽  
Clinical State ◽  
Arterial Oxygen ◽  
Low Oxygen ◽  
Arterial Blood

<p>The authors present a case of a 60-year-old male patient, previously diagnosed with B-cell chronic lymphocytic leukemia, who was admitted to the Emergency Room with dyspnea. The initial evaluation revealed severe anemia (Hgb = 5.0 g/dL) with hyperleukocytosis (800.000/µL), nearly all of the cells being mature lymphocytes, a normal chest X-ray and a low arterial oxygen saturation (89%; pulse oximetry). After red blood cell transfusion, Hgb values rose (9.0 g/dL) and there was a complete reversion of the dyspnea. Yet, subsequent arterial blood gas analysis, without the administration of supplemental oxygen, systematically revealed very low oxygen saturation values (~ 46%), which was inconsistent with the patient’s clinical state and his pulse oximetry values (~ 87%), and these values were not corrected by the administration of oxygen via non-rebreather mask. The investigation performed allowed to establish the diagnosis of oxygen leukocyte larceny, a phenomenon which conceals the true oxygen saturation due to peripheral consumption by leukocytes.</p>

scholarly journals Evaluation of physiological parameters of dogs submitted to uterine lymphatic mapping using patent blue V dye for anaphylaxis detection

2016 ◽  
Vol 36 (12) ◽  
pp. 1209-1214
Author(s):  
Rebeca C. Justino ◽  
Guilherme S. Cardoso ◽  
Luiz G.C. Trautwein ◽  
Rubens I.A. Alves ◽  
Karina K.M.C. Flaiban ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Lymphatic Mapping ◽  
Arterial Oxygen Saturation ◽  
Gas Analysis ◽  
Arterial Oxygen ◽  
Whitney Test ◽  
Patent Blue ◽  
Arterial Blood ◽  
Mann Whitney Test ◽  
Patent Blue V

ABSTRACT: Lymphatic mapping has been performed in humans and dogs. Although several cases of anaphylaxis have been reported in humans, there are no such reports in dogs. The objective of this study was to identify the occurrence of adverse reactions to patent blue V dye in bitches undergoing uterine lymphatic mapping procedures using cardiovascular and hematological evaluations. The experiment was performed in 14 mongrel bitches without any reproductive disease, randomly assigned into two equal groups (PBV- uterine lynphatic mapping and OHE; Control - OHE only). The animals were submitted to pre- and postoperative hematological and serum biochemistry exams (7 days). The anesthetic protocol was: sedation (morphine and acepromazine), induction (propofol), maintenance (isoflurane), transoperative analgesia (fentanyl). Systolic blood pressure was monitored throughout the procedure and arterial blood gas analysis was performed immediate pre and postoperatively. For lymphatic mapping was injected patent blue V in the uterine wall, 10 minutes before OEH. Comparisons between the pre- and postoperative parameters within the same animal were performed using the Wilcoxon-Mann-Whitney test. To compare the values between control and PBV group was obtaining the difference between the pre and post of each group, subjected to the Mann-Whitney test (significance of 5%). Differences were observed (P<0.05) between the pre- and postoperative evaluations in the PBV (total protein and the albumin serum), in both groups (arterial partial pressure of oxygen) and in the Control (arterial oxygen saturation). There were no signs of adverse reactions to the patent blue V dye in the healthy bitches submitted to lymphatic uterine mapping.

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