Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis

Winsö, Ola; Král, Josef; Wang, Wanzhong; Kralova, Ivana; Abrahamsson, Pernilla; Johansson, Gillis; Blind, Per-Jonas

doi:10.1080/03009734.2018.1539054

Cited by 9 publications

(3 citation statements)

References 19 publications

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“…On analysis, they concluded that TEA led to improved survival, enhanced microcirculatory perfusion, and improved tissue oxygenation with less histopathologic tissue damage in the TEA group. Winsö et al randomized 16 pigs with induced acute pancreatitis into two groups: group 1- no intervention, group 2- TEA to investigate the efficacy of TEA to reduce insulin resistance and inflammatory response in presence of acute pancreatitis [ 35 ]. Blood sugar levels, serum insulin concentration, serum lipase, and relative tissue oxygen tension (PtiO2) levels were compared in both groups.…”

Section: Reviewmentioning

confidence: 99%

Efficacy and Safety of Thoracic Epidural Analgesia in Patients With Acute Pancreatitis: A Narrative Review

Nair¹,

Tiwary²,

Seelam³

et al. 2022

Cureus

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Patients admitted to the intensive care unit with moderate to severe acute pancreatitis carry significant morbidity and mortality. A few unfortunate patients in whom the initial line of treatment fails to show clinical improvement develop multiorgan dysfunction involving lungs (adult respiratory distress syndrome), renal failure, intra-abdominal infections, sepsis, and septic shock, which ultimately leads to prolonged hospitalization and a substantial cost of treatment. The acute abdominal pain experienced by these patients is excruciating and requires multimodal analgesia. Continuous epidural analgesia has been found to provide good quality, opioid-sparing analgesia in these patients. A few studies have also demonstrated that segmental sympathectomy resulting from epidural blockade could lead to lowering of serum amylase and lipase levels improve paralytic ileus, and thus hastens the process of recovery. The present paper aims to discuss the advantages of continuous epidural analgesia in patients with acute pancreatitis of varying severity and to review the existing literature using specific keywords.

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Section: Reviewmentioning

confidence: 99%

Efficacy and Safety of Thoracic Epidural Analgesia in Patients With Acute Pancreatitis: A Narrative Review

Nair¹,

Tiwary²,

Seelam³

et al. 2022

Cureus

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“…[5][6][7] However, knowledge is lacking for some commonly used anaesthetic protocols in pigs and glucose-stimulated conditions have only been studied to a very limited extent in pigs. 8,9 Some anaesthetic drugs used in pre-clinical animal models are known to affect glucose metabolism by inhibition of insulin release and/or induction of insulin resistance, [10][11][12][13][14] making general anaesthesia a potential confounding factor in glucose metabolism studies.…”

Section: Introductionmentioning

confidence: 99%

Influence of general anaesthesia on circulating biomarkers of glucose metabolism in pigs

Christoffersen,

Bundgaard,

Hjøllund

et al. 2023

Lab Anim

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Pigs are widely used in metabolic research with procedures often requiring general anaesthesia. The aim was to investigate the effect of four different anaesthetic protocols: 1) isoflurane inhalation, 2) propofol infusion, 3) a mixture of tiletamine, zolazepam, medetomidine, ketamine and butorphanol (TZMKB)) and 4) ketamine combined with midazolam and xylazine (KMX)) on selected biomarkers during basal and glucose stimulated conditions. Eight domestic pigs were included in a cross-over design. Plasma concentrations of glucose, insulin, C-peptide, glucagon, cortisol, triglycerides, total cholesterol, aspartate amino transferase and alanine amino transferase, creatinine, urea, fructosamine, albumin, free fatty acids (FFAs) and glycerol were measured at baseline, during 2 h of anaesthesia and during 1 h of recovery. Intravenous glucose tolerance test (IVGTT, 0.5 g glucose/kg) was performed after 1 h of anaesthesia. Glucose disappearance rate and areas under the insulin, C-peptide and glucagon curves from the IVGTT were calculated. All four anaesthetic protocols affected glucose metabolism parameters significantly compared with un-anaesthetised pigs, which was particularly evident during IVGTT and for TZMKB and KMX anaesthesia. Propofol additionally influenced the plasma concentrations of triglycerides, FFAs and glycerol significantly. The remaining circulating biomarkers were largely unaffected by anaesthesia. These data underline the importance of considering the anaesthetic protocol in porcine studies of circulating metabolic biomarkers.

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“…3 Previous studies have demonstrated that thoracic epidural analgesia (TEA) could improve pancreatic and splanchnic perfusion. [4][5][6] A recent multicentre study showed that TEA reduced the mortality of patients with AP. 7 However, only 46 patients who received TEA were included in this study.…”

Section: Introductionmentioning

confidence: 99%

Impact of early thoracic epidural analgesia in patients with severe acute pancreatitis

Qiu

et al. 2022

Eur J Clin Investigation

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Objective: This study was designed to assess the impact of thoracic epidural analgesia (TEA) in patients with severe acute pancreatitis (SAP).Methods: This is a single-centre retrospective study. In this study, the outcomes of SAP patients were compared between patients received TEA (TEA group) and without TEA (NTEA group). Early TEA was defined as TEA performed within 48 hours after onset. The main outcome was the mortality at 30 days after ICU admission, and secondary outcomes included the incidence of acute respiratory distress syndrome (ARDS), the acute renal injury (AKI) and sepsis, the hospital stay and hospitalization expenses. Results:The mortality of SAP patients in TEA versus NTEA was 8.0% and 13.3% (p = .1520). Multivariate regression analysis showed significant difference in mortality between the TEA and NTEA groups (OR, 0.387; 95% CI, 0.168-0.892; p = .026). The incidence of ARDS in TEA versus NTEA was 46.0% and 62.4% (p = .0044); the proportion of patients requiring invasive ventilator assisted ventilation in TEA, and NTEA was 22.6% and 39.2% (p = .0016). The incidence of AKI in TEA versus NTEA was 27.7% and 45.3% (p = .0044); the proportion of patients needing for continuous renal replacement therapy (CRRT) in TEA and NTEA was 48.2% and 74.0% (p < .0001). The mortality of SAP patients in early TEA versus NTEA was 4.8% and 15.3% (p = .0263). Conclusions: TEA was associated with low incidence of ARDS and AKI in patients with SAP. Early TEA may benefit mortality in SAP patients and is a possible protective factor for the mortality of SAP patients.

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Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis

Cited by 9 publications

References 19 publications

Efficacy and Safety of Thoracic Epidural Analgesia in Patients With Acute Pancreatitis: A Narrative Review

Efficacy and Safety of Thoracic Epidural Analgesia in Patients With Acute Pancreatitis: A Narrative Review

Influence of general anaesthesia on circulating biomarkers of glucose metabolism in pigs

Impact of early thoracic epidural analgesia in patients with severe acute pancreatitis

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