Epidural anesthesia and splanchnic perfusion

Sielenkämper, Andreas W.; Brodner, G.; Aken, Hugo Van

doi:10.1007/bf03016842

Cited by 4 publications

(5 citation statements)

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“…However, the splanchnic mucosa particularly possesses powerful autoregulation, preserving microcirculatory oxygenation even during decreased systemic and splanchnic oxygendelivery. 24 Those studies reporting the effects of epidural anaesthesia on the gastrointestinal mucosa mainly studied surrogate markers (e.g., tonometrically assessed PCO 2 -gap or pHi), and report divergent results, 25 for example improved, 8 unchanged, 6 7 or even decreased 26 mucosal perfusion. These conflicting results may be a result of differences in study design, including type (e.g.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…These conflicting results may be a result of differences in study design, including type (e.g. spread) of epidural anaesthesia, 25 but may also depend on the measurement site. For example, high epidural anaesthesia improved pHi of the native stomach and colon, but decreased pHi of a surgically manipulated colon segment within the same patients.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

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Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs †

Schwarte

Picker

Höhne

et al. 2004

British Journal of Anaesthesia

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Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Interpretation Of Resultsmentioning

confidence: 99%

Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs †

Schwarte

Picker

Höhne

et al. 2004

British Journal of Anaesthesia

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“…Застосування торакальної епідуральної аналгезії (ЕДА) у пацієнтів з ІАГ супроводжувалось зниженням ІАТ, що пов'язували із покращенням комплаєнсу черевної стінки, а також із відновленням перистальтики і зниженням екстравазації у третій простір [20]. Використання ЕДА на торакальних рівнях за даними експериментальних досліджень Shäper та ін., Freise та ін., призводило до збільшення гастроінтестінального кровоплину у великих судинах, а також за даними Hogan та ін., Sielenkämper та ін., Adolphs та ін., до зросту мікроциркуляції слизової кишечної стінки та ворсинок виміряних методом флюоресцентних мікросфер та прижиттєвої мікроскопії [21,22,23,24,25]. Однак, за даними Sivarajan та ін., Ai та ін., та Vagts та ін., застосування ЕДА не супроводжувалось покращенням спланхнічного кровоплину у тварин [26,27,28].…”

Section: вступunclassified

The Influence of Postoperative Analgesia Techniques on Splanchic Blood Flow in Children With Intraabdominal Hypertension

Перова-Шаронова¹

2021

Pain Anaesth Int Care

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Introduction. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) often develop in critically ill patients and can lead to affected splanchnic blood flow, intestinal mucosal ischemia, bacterial translocation, sepsis, and multiorgan dys-function. There is limited literature data on the effect of analgesic methods on splanchnic blood flow in IAG / AСS. The aim of the study was to define the effect of different postoperative analgesia techniques on splanchnic blood flow in children with appendicular peritonitis with IAH. Materials and methods. The study included 115 children who underwent surgery for appendicular peritonitis. Children were randomized into three groups depending on the method of postoperative analgesia: “Opioids” (n = 36; intravenous infusion of morphine 10 μg/kg/h); “Lidocaine” (n = 40; intravenous infusion of lidocaine 1.5 mg/kg/h); “EDA” (n = 39; epidural infusion 0.25% bupivacaine 0.4 mg/kg/h). Postoperatively intraabdominal pressure (IAP) was measured 4 times a day using the standard in-direct method through a Foley catheter in the bladder. According to the IAP level and presence of organ dysfunction patients in each group were divided in subgroups: “Without IAH”, “IAH” and “ACS”. The diameters and linear velocities of blood flow in the superior mesenteric artery (SMA) and portal vein (PV) were detected using US. The blood flow indices in SMA and PV (BFISMA, BFIPV, ml/min/m2) were calculated. Results. BFISMA and BFIPV were significantly higher in children without IAH than in children with IAH (p <0.0001) and ACS (p <0.0001). Among patients in all subgroups, BFISMA was significantly higher in the groups “Lidocaine” (p <0.05) and “EDA” (p <0.0001) compared with the group “Opioids”. BFIPV was higher in the group “EDA” (p <0.05) in children with IAH and in the groups “Lidocaine” (p <0.0001) and “EDA” (p <0.0001) in children with ACS compared with children of all subgroups in the group “Opioids”. Among the children without IAH a statistically significant negative correlation between IAP and BFISMA was observed only in the group “Opioids” (rs = -0.5; p <0.001). Among the children with IAH and ACS, a statistically significant negative correlation between IAP and BFISMA was observed in all analgesia groups, but it was weakest in the group “EDA” (rs = -0.24; p <0.04 and rs = -0.39; p <0.05, respectively). In the group “Opioids” a statistically significant negative correlation between IAP and BFIPV was observed only in the children with IAH (rs=-0.31; p<0.01) and ACS (rs=-0.4; p<0.0001). Conclusions. Epidural analgesia is the most optimal method of analgesia for the effect on impaired splanchnic blood flow in children with peritonitis complicated with intra-abdominal hypertension. Intravenous analgesia with lidocaine may be an alternative to epidural anesthesia.

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“…Intravital microscopy of the ileus was used as an indirect measure of splanchnic flow in 5 studies [1014] . Sielenkämper et al [10] found, in anesthetized rats treated with epidural bupivacaine, an increase in arteriolar red blood cell velocity, expressing an increase in gut mucosal blood flow despite a lower MAP. Also, intercapillary area calculated for continuously perfused capillaries, was reduced in the TEA group, indicating a decrease in intermittent blood flow in the villus microcirculation.…”

Section: Effects Of Epidural Anesthesia On Splanchnic Circulationmentioning

confidence: 99%

“…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.…”

Section: Rabbits Hoganmentioning

confidence: 99%

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

Siniscalchi

Gamberini

Laici

et al. 2015

WJCCM

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AIM:To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions. METHODS:A PubMed search was conducted using the MeSH database. Anesthesia, Epidural was always the first MeSH heading and was combined by boolean operator AND with the following headings: Circulation, Splanchnic; Intestines; Pancreas and Pancreatitis; Liver Function Tests. EMBASE, Cochrane library, ClinicalTrials. gov and clinicaltrialsregister.eu were also searched using the same terms. RESULTS:Twenty-seven relevant studies and four ongoing trials were found. The data regarding the effects of epidural anesthesia on splanchnic perfusion are conflicting. The studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery, demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia (TEA). On the other hand most of the studies focusing on micro-hemodynamics, especially in pathologic low flow conditions, suggested that TEA could foster microcirculation. CONCLUSION:The available studies in this field are heterogeneous and the results conflicting, thus it is difficult to draw decisive conclusions. However there is increasing evidence deriving from animal studies, that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage, regardless of the effects on macro-hemodynamics.

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Epidural anesthesia and splanchnic perfusion

Cited by 4 publications

References 6 publications

Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs †

Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs †

The Influence of Postoperative Analgesia Techniques on Splanchic Blood Flow in Children With Intraabdominal Hypertension

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

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