The influence of thoracic epidural anesthesia on liver hemodynamics in patients under general anesthesia

Abstract

Background and objective. Hepatic hypoperfusion is regarded as an important factor in the pathophysiology of perioperative liver injury. Although thoracic epidural anesthesia is a widely used technique, limited data are available about the effects on hepatic blood flow with blockade restricted to thoracic segments in humans. The main objective of the present study was to investigate the effects of thoracic epidural anesthesia on hepatic blood flow under general anesthesia in humans. Material and methods. In 40 patients under general anesthesia, we assessed hepatic blood flow using plasma disappearance rate of indocyanine green (PDRICG) as a simple noninvasive method before and after induction of thoracic epidural anesthesia. The epidural catheter was inserted at the Th7/8 or Th8/9, and 1% lidocaine at a mean (range) dose of 8 (6–10) mL was injected. Ephedrine bolus was given to patients who demonstrated a decrease in mean arterial blood pressure below 60 mm Hg after induction of thoracic epidural anesthesia (TEA-E group). Other patients did not receive any catecholamines during the study period (TEA group). Ten patients who did not undergo TEA served as controls (control group). Results. In 7 patients, administration of ephedrine was necessary to avoid a decrease in mean arterial blood pressure below 60 mm Hg. Thus, the TEA-E group consisted of 7 patients and TEA group of 33. In the TEA group, thoracic epidural anesthesia was associated with a mean 2.3% min–1 decrease in PDRICG (P<0.05). In the TEA-E group, all seven patients showed a 2.2% min–1decrease in PDRICG (P<0.05). Patients in the control group showed a mean 1.1% min–1 increase in PDRICG (P<0.05). In contrast to hepatic blood flow, cardiac output was not affected by thoracic epidural anesthesia. Conclusions. In humans, thoracic epidural anesthesia is associated with a decrease in hepatic blood flow. Thoracic epidural anesthesia combined with ephedrine bolus was found to result in further decrease in hepatic blood flow.

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

“…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. Trepenaitis et al [24] found a reduction of PDRICG in patients undergoing upper abdominal surgery with TEA. This data was not associated with a fall in CO and could not be reversed by administration of vasopressors.…”

“…Three studies [24] used centrally injected radio active or colored microspheres to determine cardiac output and regional blood flow. The regional flow could be estimated by measuring organ or regional arterial blood samples radioactivity, or by microscopy after autopsy.…”

“…The reduction in blood flow was resistant to the correction of hypotension using vasopressors. Michelet et al [22] used doppler flowmetry to evaluate gastric mucosal blood flow in patients [24] 2010 Siniscalchi A et al . Thoracic epidural anesthesia undergoing oesophagectomy.…”

“…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.…”

Effects of Thoracic Epidural Anesthesia on Liver Blood Flow and Indocyanine Green Clearance Test in Living-Donor Liver Transplantation: A Prospective, Randomized, Double-Blind Study

“…However, hypotension is the result of decrease in systemic vascular resistance, and this may reduce hepatic blood flow. Lumbar thoracic anesthesia is shown to reduce liver blood flow in nonhuman and human studies [2]. Patients undergoing major abdominal surgery, such as hepatectomy, are at risk for postoperative complications, including multiple organ failure.…”