Effects of epidural anaesthesia on intestinal oxygenation in pigs †

Vagts, Dierk A.; Iber, Thomas; Szabó, Béla; Haberstroh, Jörg; Reising, Kilian; Puccini, Marcus; Geiger, K.; Nöldge-Schomburg, Gabriele

doi:10.1093/bja/aeg039

Cited by 32 publications

(32 citation statements)

References 27 publications

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“…Vagts et al reported that TEA did not affect renal blood flow and urine output in healthy pigs (14). In our study, however, TEA increased urine output by 36% as compared with the control group.…”

contrasting

confidence: 79%

Effects of Thoracic Epidural Anesthesia on Hemodynamics and Global Oxygen Transport in Ovine Endotoxemia

Daudel

Bone²,

Traber³

et al. 2006

Shock

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Besides providing effective analgesia, thoracic epidural anesthesia (TEA) has been shown to decrease perioperative morbidity and mortality. Because of its vasodilatory properties in association with the sympathetic blockade, however, TEA may potentially aggravate cardiovascular dysfunctions resulting from sepsis and systemic inflammatory response syndrome. The objective of the present study was to assess the effects of TEA on hemodynamics, global oxygen transport, and renal function in ovine endotoxemia. After a baseline measurement in healthy sheep (n = 18), Salmonella typhosa endotoxin was centrally infused at incremental doses to induce and maintain a hypotensive-hypodynamic circulation using an established protocol. The animals were then randomly assigned to one of two groups. In the treatment group, continuous TEA was initiated with 0.1 mL.kg of 0.125% bupivacaine at the onset of endotoxemia and maintained with 0.1 mL.kg.h. In the control group, the same amount of isotonic sodium chloride solution was injected through the epidural catheter. In the animals surviving the entire experiment (n = 7 per group), cardiac index and mean arterial pressure decreased in a dose-dependent manner during endotoxin infusion. In the TEA group, neither systemic hemodynamics nor global oxygen transport were impaired beyond the changes caused by endotoxemia itself. Urinary output was increased in the TEA group as compared with the control group (P < 0.05). In this model of endotoxic shock, TEA improved renal perfusion without affecting cardiopulmonary hemodynamics and global oxygen transport.

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contrasting

confidence: 79%

Effects of Thoracic Epidural Anesthesia on Hemodynamics and Global Oxygen Transport in Ovine Endotoxemia

Daudel

Bone²,

Traber³

et al. 2006

Shock

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“…In contrast to this, in healthy anesthetized pigs, midthoracic TEA including all splanchnic sympathetic nerves did not change intestinal perfusion [22]. In healthy rats, TEA alone affected neither mucosal nor serosal microcirculation [23].…”

Section: Introductioncontrasting

confidence: 57%

“…In the rat study, a 50% reduction in blood pressure in association with a 30% reduction in heart rate suggested a profound decrease in cardiac output [26]. In contrast to this, in the face of a 30% reduction in arterial blood pressure, intestinal perfusion remained undisturbed in instrumented pigs [22].…”

Section: Introductionmentioning

confidence: 96%

Intestinal effects of thoracic epidural anesthesia

Freise

Fischer²

2009

Current Opinion in Anaesthesiology

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“…Hypotension due to a decrease in systemic vascular resistance or cardiac output is a known side-effect of central neuraxial anaesthesia in animals and humans [3,5,15,16] . The magnitude and duration of hypotension were most distinct in the TEA10 and TEA30 groups and exceeded the values of LEA30 animals.…”

Section: Haemodynamic Parametersmentioning

confidence: 99%

“…Furthermore, the extent of the sympathetic blockade is often solely demonstrated by a decrease in cardiac sympathetic outfl ow [3,5] , motor blockade of hind limbs [1,6] or (epidural) spread of dye [2,7] . The most accurate method to prove regional sympathetic block is by measuring efferent neuronal activity [8] , which requires direct access to neuronal structures, sophisticated technical equipment and expertise.…”

mentioning

confidence: 99%

Evaluation of Sympathetic Blockade after Intrathecal and Epidural Lidocaine in Rats by Laser Doppler Perfusion Imaging

Adolphs¹,

Schmitt

Schmidt³

et al. 2005

Eur Surg Res

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The widespread use of neuraxial anaesthesia increases the need for animal models to evaluate therapeutic prospects, mechanisms and risks of this technique. As a methodological prerequisite, we characterised the sympathetic blockade after different modes of neuraxial anaesthesia with regard to segments supplying the splanchnic region. Under haemodynamic monitoring, lidocaine 2% or saline were infused via intrathecal (10 µl), lumbar epidural (10 and 30 µl) or thoracic epidural (10 and 30 µl) catheters. Segmental spread of neuraxially infused local anaesthetic was assessed using methylene blue. Mean arterial blood pressure decreased more severely after neuraxial lidocaine in thoracic epidural (10 and 30 µl) compared to high-volume (30 µl) lumbar anaesthesia animals. Determination of the sympathetic blockade by means of laser Doppler perfusion imaging was restricted to the paws due to a higher density of subcutaneous blood vessels as compared to the abdominal wall (mean ± SD: 3.93 ± 0.06 vs. 1.35 ± 0.05/384 mm², p < 0.05). Only high-volume (30 µl) lumbar and thoracic epidural anaesthesia (10 and 30 µl) increased skin perfusion in both hind and front paws. This extensive sympathetic blockade was demonstrated to include splanchnic segments using thermography. Segmental spread of methylene blue did not closely correspond to laser Doppler findings and should be interpreted as minimum rather than exact epidural spread of local anaesthetic.

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Effects of epidural anaesthesia on intestinal oxygenation in pigs †

Abstract: Despite marked systemic hypotension, epidural anaesthesia did not affect intestinal oxygenation. There was no benefit obtained from volume loading.

Cited by 32 publications

References 27 publications

Effects of Thoracic Epidural Anesthesia on Hemodynamics and Global Oxygen Transport in Ovine Endotoxemia

Effects of Thoracic Epidural Anesthesia on Hemodynamics and Global Oxygen Transport in Ovine Endotoxemia

Intestinal effects of thoracic epidural anesthesia

Evaluation of Sympathetic Blockade after Intrathecal and Epidural Lidocaine in Rats by Laser Doppler Perfusion Imaging

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