The influence of epidural blockade on gut permeability in patients undergoing open surgical repair of abdominal aortic aneurysm

Abstract

Background: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes. Methods: Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio. Results: No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G. Conclusions:Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.

The gut microbiome and cardiovascular disease: current knowledge and clinical potential

“…In addition, gut microbiota function is affected by surgical abdominal aortic repair, which involves aortic clamping and can result in negative changes in intestinal permeability, which may also contribute to disease progression (109).…”

Ventajas del uso de anestesia epidural en cirugía abdominal

“…Los bloqueos epidurales tienen efectos beneficiosos sobre los órganos vitales durante la cirugía abdominal. Sin embargo, un estudio fue llevado a cabo, al existir poca evidencia disponible acerca de la influencia de este tipo de anestesia sobre la permeabilidad intestinal durante cirugía aórtica abierta; concluyendo que, durante esta, el pinzamiento aórtico provocaba cambios desfavorables en la permeabilidad intestinal y que el bloqueo epidural no logró atenuar este deterioro (26).…”

Boronic acid recognition of non-interacting carbohydrates for biomedical applications: increasing fluorescence signals of minimally interacting aldoses and sucralose

“…22,33 We were interested in quantifying xylose and l -rhamnose, as these aldoses have also been used to study intestinal permeability. 34 Sucralose, a non-reducing trichlorinated sucrose, is used as a marker for colon permeability as it is resistant to fermentation by colonic bacteria. 35,36 Carbon–chloride bonds in sucralose were converted into carbon–hydroxyl bonds by the Fenton reaction.…”