Effects of thoracic epidural anesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial

Abstract

IntroductionSevere acute pancreatitis is still a potentially life threatening disease with high mortality. The aim of this study was to evaluate the therapeutic effect of thoracic epidural anaesthesia (TEA) on survival, microcirculation, tissue oxygenation and histopathologic damage in an experimental animal model of severe acute pancreatitis in a prospective animal study.MethodsIn this study, 34 pigs were randomly assigned into 2 treatment groups. After severe acute pancreatitis was induced by intraductal injection of glycodesoxycholic acid in Group 1 (n = 17) bupivacaine (0.5%; bolus injection 2 ml, continuous infusion 4 ml/h) was applied via TEA. In Group 2 (n = 17) no TEA was applied. During a period of 6 hours after induction, tissue oxygen tension (tpO2) in the pancreas and pancreatic microcirculation was assessed. Thereafter animals were observed for 7 days followed by sacrification and histopathologic examination.ResultsSurvival rate after 7 days was 82% in Group 1 (TEA) versus 29% in Group 2: (Control) (P <0.05). Group 1 (TEA) also showed a significantly superior microcirculation (1,608 ± 374 AU versus 1,121 ± 510 AU; P <0.05) and tissue oxygenation (215 ± 64 mmHg versus 138 ± 90 mmHG; P <0.05) as compared to Group 2 (Control). Consecutively, tissue damage in Group 1 was reduced in the histopathologic scoring (5.5 (3 to 8) versus 8 (5.5 to 10); P <0.05).ConclusionsTEA led to improved survival, enhanced microcirculatory perfusion and tissue oxygenation and resulted in less histopathologic tissue-damage in an experimental animal model of severe acute pancreatitis.

Thoracic epidural anesthesia: Effects on splanchnic circulation and implications in Anesthesia and Intensive care

“…Animal models of acute pancreatitis treated with thoracic epidural blockade [13,16] , showed reduced histologic signs of pancreatic necrosis and a restoration of continuous capillary perfusion and arteriolar blood flow, moreover, survival rate was significantly higher in both of the studies. The microcirculatory effects induced by TEA could contribute in interrupting the ischemic injury involved in the beginning and progression of pan creatic lesions.…”

“…Bachmann et al [16] , evaluated a porcine model of acute pancreatitis finding that TEA enhanced [13] 2006 [23] 1997…”

“…The six studies using surrogate hemodynamic parameters had conflicting results. Tanaka et al [23] used PDRicg as indirect measure of hepatic blood [7] Hogan et al [8] Sielenkämper et al [10] Adolphs et al [12] Adolphs et al [11] Schwarte et al [15] Kosugi et al [9] Freise et al [13] Daudel et al [14] Bachmann et al [16] Tanaka et al [23] Väisänen et al [25] Spackman et al [26] Gould et al [20] Michelet et al [22] Kortgen et al [27] Meierhenrich et al [21] Trepenaitis et al [24] Treatment Meissner et al [4] Ai et al [6] Vagts et al [5] Shäper et al [3] Freise et al [17] Freise et al [18] Treatment allocation Siniscalchi A et al . Thoracic epidural anesthesia flow, finding that TEA reduced blood flow to the liver, fluid resuscitation alone could not reverse this effect but had to be associated with dopamine infusion.…”

Anesthetics considerations in peritonitis

“…These effects reduce the incidence of respiratory complica- Establishing a multi-modal analgesia is paramount, with a well-established central role of neuraxial continuous analgesia in patients at risk of prolonged ileus, as well as patients with increased cardiac or respiratory risk. 22,23 Neuraxial block (thoracic epidural) is preferable to other extra-axial blocks such as paravertebral block, tranversus abdominis plane (TAP) block, rectus sheath block and continuous wound infusion, since the first also has a desired positive effect on bowel function and pancreatic microcirculation 24,25 as well as ensuring improved cardiac protection. 26,27 Sepsis is not a contraindication itself, so only serious hemodynamic instability (i.e., septic shock -as is the case for every loco-regional anesthesia maneuver, and most notably neuraxial ones), coagulopathy, and existing anticoagulant therapy should be considered absolute contraindications to this technique.…”

Time Trend of Outcomes for Severe Acute Pancreatitis After Publication of Japanese Guidelines Based on a National Administrative Database

“…[2][3][4] Severe acute pancreatitis is characterized as a high-mortality disease despite continuing improvements in critical care. 4,5 Therefore, severe acute pancreatitis has been recognized as a life-threatening disease with a poor prognosis.…”