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Epidural anesthesia during surgery: friend or foe?

Introduction

Decreased intestinal microcirculatory blood flow (MBF) is an important contributor to perioperative morbidity. Epidural anesthesia (EA) may improve intestinal MBF [1] but other researchers found that EA decreases cardiac output (CO) and thus compromises intestinal MBF [2]. We tested whether EA plus intravenous colloids result in increased intestinal MBF compared with colloid administration alone.

Methods

Twenty pigs (30 ± 2.5 kg) were anesthetized and ventilated. A laparotomy was performed for instrumentation and a colon anastomosis. After baseline measurements the animals were randomly assigned to one of the following treatments: Group HES, hydroxyethyl starch (130/0.4) was given to maintain SvO2 ≥ 60%; Group EA, in addition to the same colloid treatment an epidural catheter was inserted at the lumbar level and after a bolus of 4 ml ropivacain 0.2%, 7 ml/hour were continuously administered. The CO and MBF in the mucosa of the jejunum, colon and anastomosis were measured.

Results

In both groups the CO and MBF increased similarly (Table 1). No difference in the circulatory parameters between the two groups was found. However, in Group EA significantly more fluids (56%) were administered to achieve SvO2 ≥ 60%.

Table 1 Comparison of the treatment groups

Conclusion

The present study did not show any positive effects of epidural anesthesia on intestinal microcirculatory blood flow. On the contrary, over 50% more fluids were needed to maintain similar perfusion parameters than with fluids alone. Such a fluid load as needed in the epidural group may potentially be harmful.

References

  1. 1.

    Sielenkämper AW, et al.: Thoracic epidural anesthesia increases mucosal perfusion in ileum of rats. Anesthesiology 2000, 93: 844-851. 10.1097/00000542-200009000-00036

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  2. 2.

    Schwarte LA, et al.: Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs. Br J Anaesth 2004, 93: 552-559. 10.1093/bja/aeh235

    CAS  Article  Google Scholar 

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Koepfli, E., Brandt, S., Kimberger, O. et al. Epidural anesthesia during surgery: friend or foe?. Crit Care 13, P393 (2009). https://doi.org/10.1186/cc7557

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Keywords

  • Cardiac Output
  • Ropivacain
  • Epidural Anesthesia
  • Hydroxyethyl
  • Epidural Catheter