Thoracic epidural anesthesia reverses sepsis-induced hepatic hyperperfusion and reduces leukocyte adhesion in septic rats

Abstract

IntroductionLiver dysfunction is a common feature of severe sepsis and is associated with a poor outcome. Both liver perfusion and hepatic inflammatory response in sepsis might be affected by sympathetic nerve activity. However, the effects of thoracic epidural anesthesia (TEA), which is associated with regional sympathetic block, on septic liver injury are unknown. Therefore, we investigated hepatic microcirculation and inflammatory response during TEA in septic rats.MethodsForty-five male Sprague-Dawley-rats were instrumented with thoracic epidural catheters and randomized to receive a sham procedure (Sham), cecal ligation and puncture (CLP) without epidural anesthesia (Sepsis) and CLP with epidural infusion of 15 ul/h bupivacaine 0.5% (Sepsis + TEA). All animals received 2 ml/100 g/h NaCl 0.9%. In 24 (n = 8 in each group) rats, sinusoidal diameter, loss of sinusoidal perfusion and sinusoidal blood flow as well as temporary and permanent leukocyte adhesion to sinusoidal and venolar endothelium were recorded by intravital microscopy after 24 hours. In 21 (n = 7 in each group) separate rats, cardiac output was measured by thermodilution. Blood pressure, heart rate, serum transaminase activity, serum TNF-alpha concentration and histologic signs of tissue injury were recorded.ResultsWhereas cardiac output remained constant in all groups, sinusoidal blood flow increased in the Sepsis group and was normalized in rats subjected to sepsis and TEA. Sepsis-induced sinusoidal vasoconstriction was not ameliorated by TEA. In the Sepsis + TEA group, the increase in temporary venolar leukocyte adherence was blunted. In contrast to this, sinusoidal leukocyte adherence was not ameliorated in the Sepsis + TEA group. Sepsis-related release of TNF-alpha and liver tissue injury were not affected by Sepsis + TEA.ConclusionsThis study demonstrates that TEA reverses sepsis-induced alterations in hepatic perfusion and ameliorates hepatic leukocyte recruitment in sepsis.

Regional Anesthesia Continuous Brachial Plexus Block With Ultrasonography Guidance

“…It shows there is a possibility of regional anesthesia anti-inflammatory effects due to blockade of C fibers, 7 thereby reducing the production of cytokines 8 and block the activity of the sympathetic nerve fibers. [9][10] Therefore, postoperative pain caused primarily by tissue inflammation and activation of C-fibers by reducing the production of cytokines that may limit the inflammatory response after surgery and postoperative pain severity. 17,18,19 In research Yasukawa found that IL-6 induces the formation of an anti-inflammatory cytokine IL-10 11 thus with suppressed IL-6 in the RAM group cause lowered levels of increased in IL-10 compared with GAM group.…”

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

“…In healthy animals, TEA did not exert any effect on the evaluated microcirculation parameters. In a sepsis model induced by cecal ligation and perforation [18] , TEA was able to normalize the increase in blood flow to the liver and to decrease temporary leucocyte adhesion to the venular endothelium, but not the vasoconstriction of hepatic vasculature and temporary sinusoidal leukocyte adhesion, both induced by sepsis.…”

“…Two studies by Freise et al [17,18] used intravital microscopy to assess hepatic microcirculation in different pathologic animal models. In acute pancreatitis in rats [17] , TEA prevented the vasoconstriction of sinusoids, but could not reduce the number of non perfused sinusoids.…”

“…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.…”

“…Studies focusing on regional macrohemodynamics in healthy animals [2,5] and humans undergoing elective surgery [1921,2325] demonstrated no influence or worsening of regional perfusion in subject receiving thoracic epidural anesthesia. On the other hand most of the studies focusing on microhemodynamics [712,17,18] , especially those focusing on pathologic low flow conditions, suggested that TEA could foster microcirculation despite a reduction in mean perfusion pressure.…”