The effect of epidural blockade on gastric intramucosal pH in the peri‐operative period

Sutcliffe, N. P.; Gannon, John; Harper, S.

doi:10.1111/j.1365-2044.1996.tb07651.x

Cited by 22 publications

(23 citation statements)

References 9 publications

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“…3 , 4 The risk of developing gut ischemia and multiple organ failure (MOF) has been recognised in patients undergoing major surgery. 5 The systemic hemodynamic effects of infrarenal aortic cross-clamping during abdominal aortic surgery are unfavourable, 6 -8 because clamping increases myocardial work and reduces cardiac output. 9 In addition, the splanchnic region appears to play a pivotal role in the development of MOF in patients undergoing major surgery.…”

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confidence: 99%

“…1 0 Patients who suffer perioperative splanchnic ischemia have a poor outcome. 5 The central role of the gastrointestinal tract in the development of MOF suggests that outcome can be improved if gut ischemia is prevented by techniques which improve splanchnic blood flow. 1 1 It has been demonstrated that epidural anesthesia has a beneficial effect on bowel function.…”

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confidence: 99%

“…1 2 Lumbar and thoracic epidural analgesia may be associated with an increase in splanchnic perfusion due to sympathetic blockade. 5,13,14 In the perioperative period systemic and local humoral regulators for controlling blood flow appear to be of importance for sufficient tissue perfusion. 5 These substances may be influenced either by the technique of anesthesia and analgesia or by altered release and metabolism.…”

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RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

Piper

Boldt

Schmidt

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To evaluate the effects of perioperative epidural analgesia on hemodynamics, splanchnic perfusion and regulators of circulation.Methods: Twenty patients undergoing aortic surgery were randomised into two groups: epidural analgesia group (EAG): epidural analgesia with bupivacaine (15 ml, 0.125%) was started before surgery. Eight and 16 hr postoperatively 10 ml bupivacaine 0.125% and 1 mg morphine were given. Control group (COG): patients received no epidural catheter. Monitoring included pulmonary artery catheter and gastric tonometer. Norepinephrine, epinephrine, renin, ADH, ANP and endothelin were measured: before epidural analgesia (T0), before aortic clamping (T1), 20 min after aortic clamping (T2), after declamping the first leg (T3), at end of surgery (T4), one hour (T5) and 24 hr postoperatively (T6).Results: At T5 mean arterial blood pressure decreased in EAG compared with baseline (86 ± 16 to 75 ± 8 mmHg) and compared with COG (75 ± 8 vs 84 ± 11 mmHg). At T2 pulmonary capillary wedge pressure and cardiac index increased and at T6 decreased in both groups. Systemic vascular resistance decreased at T1 and at T3-T5 in EAG compared with COG and at T1 and T3-T6 to baseline (1472 ± 448 to 1027 ± 184 dyn· sec·cm). In EAG and in COG, pHi decreased compared with baseline but without group differences. In both groups, epinephrine, norepinephrine, renin, and ADH levels increased from baseline. Endothelin and ANP levels showed no changes.Conclusions: Perioperatively administrated epidural bupivacaine has no beneficially effects on hemodynamics, pHi or release of regulators of circulation.Objectif : Étudier les effets de l'analgésie péridurale périopératoire sur l'hémodynamie, la perfusion splanchnique et les régulateurs de la circulation.Méthode : Vingt patients subissant un pontage aortique infrarénal ont été répartis au hasard en deux groupes : un groupe GP recevant l'analgésie péridurale avec bupivacaïne (15 ml à 0,125 %) avant l'opération, suivis de 10 ml de bupivacaïne à 0,125 % et de 1 mg de morphine 8 h et 16 h après l'opération; un groupe témoin GT sans cathéter épidural. Le monitorage comprenait un cathéter de l'artère pulmonaire et un tonomètre gastrique. Les régulateurs de circulation étaient mesurés sur des échantillons de sang : avant l'analgésie péridurale (T 0 ), avant le clampage aortique (T 1 ), 20 min après le clampage aortique (T 2 ), après déclampage de l'artère iliaque d'un côté (T 3 ), à la fin de l'opération (T 4 ), 1 h après l'opération (T 5 ) et 24 h après l'opération (T 6 ).Résultats : À T5, la pression artérielle moyenne diminuait dans le GP par rapport aux mesures initiales (86 ± 16 à 75 ± 8 mmHg) et comparé au GT (75 ± 8 vs 84 ± 11 mmHg). À T 2 , la pression capillaire pulmonaire et l'index cardiaque étaient élevés et à T 6 diminués de façon similaire dans les deux groupes. Les résistances vasculaires systémiques diminuaient à T 1 et T 3 -T 5 dans le GP en comparaison avec le GT et à T 1 et T 3 -T 6 par rapport aux mesures initiales (1472 ± 448 à 1027 ± 184 dyn"sec/cm 5"m2. Dans...

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RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

Piper

Boldt

Schmidt

et al. 2000

Can J Anesth/J Can Anesth

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“…[9,10] In addition, studies carried out on animals and humans have demonstrated that epidural anesthesia with local anesthetics during surgical stimulation maintains intestinal mucosal blood flow and gastric mucosal pH at physiological levels comparable with controls treated with general anesthetics. [11][12][13] It has been hypothesized that the increased mucosal flow can promote anastomotic healing. [14] In fact, retrospective cohort controlled studies suggest that regional anesthetic techniques are associated with a beneficial effect on anastomotic healing rates.…”

Section: Resultsmentioning

confidence: 99%

“…[14] In fact, retrospective cohort controlled studies suggest that regional anesthetic techniques are associated with a beneficial effect on anastomotic healing rates. [10][11][12][13][14][15] The stimulatory effect of epidural anesthesia on gastrointestinal mobility can lead to theoretical concern about increasing anastomotic leakage, but segmental autonomic blockade may increase the blood supply to the anastomosis and improve healing. In a recently published meta-analysis, the rate of anastomotic leakage remained the same, regardless of the analgesic technique used.…”

Section: Resultsmentioning

confidence: 99%

Effect of epidural anesthesia on anastomotic leakage in colonic surgery: experimental study

Adanir¹,

Aksun²,

Karaören³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇBir hayvan modelinde, sürekli epidural anestezi ile kolon anastomozunun gücü arasındaki ilişki araştırıldı. GEREÇ VE YÖNTEMBeyaz erkek 14 adet Yeni Zelanda tavşanı çalışmaya alındı ve randomize iki grup oluşturuldu. Grup 1'de (n=7) epiduralden sürekli olarak %0,9'luk NaCl infüzyonu (0,4 mlkg -1 bolus ve 0,2 mlkg -1 sa -1 infüzyon) ve Grup 2'de (n=7) epiduralden sürekli olarak %1'lik lidokain infüzyonu (0,4 mlkg -1 bolus ve 0.2 ml kg -1 sa -1 infuzyon) uygulandı. İnfüz-yonlara, operasyonların başında başlandı ve cerrahi sonrası 6. saate kadar sürdürüldü. Bütün deney hayvanlarına genel anestezi altında sağ kolon rezeksiyonu ve kolo-kolonik anastomoz uygulandı. Cerrahi sonrası 4. gün, re-laparotomi yapılıp in situ olarak anastomoz patlama basınçları ölçüldü. Dikiş hattını içine alan 1 cm'lik segment çıkartılıp, hidroksiprolin ve kollajen düzeyleri ölçüldü. BULGULARAnastomoz patlama basınçları, epidural lidokain grubunda (medyan 248 mmHg -[117-300]) serum fizyolojik grubuna (medyan 109 mmHg -[47-176]) göre anlamlı derecede yüksek bulundu (p=0,006). Doku örneğindeki hidroksiprolin ve kollajen düzeyleri açısından gruplar arasında fark yoktu (p>0,05). SONUÇKolon anastomozunun dayanıklılığının epidural lidokain infüzyonu ile artabileceğini düşünüyoruz.Anahtar Sözcükler: Anastomoz dayanıklılığı; kolon cerrahisi; epidural anestezi; lidokain.

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Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

Guay

Nishimori

Kopp

2016

Cochrane Database of Systematic Reviews

123

111

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The effect of epidural blockade on gastric intramucosal pH in the peri‐operative period

Abstract: SummaryThe significance qf these results is discussed.

Cited by 22 publications

References 9 publications

RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

Effect of epidural anesthesia on anastomotic leakage in colonic surgery: experimental study

Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

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