This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (29) Citing Articles via Google Scholar Google Scholar Articles by Kapral, S. Articles by Lehofer, F. Search for Related Content PubMed PubMed Citation Articles by Kapral, S. Articles by Lehofer, F.

---

REGIONAL ANESTHESIA AND PAIN MANAGEMENT

The Effects of Thoracic Epidural Anesthesia on Intraoperative Visceral Perfusion and Metabolism

Stephan Kapral, MD^*, Gabriele Gollmann, MD, Dietmar Bachmann, MD, Barbara Prohaska, MD, Rudolf Likar, MD, Oliver Jandrasits, MD^*, Christian Weinstabl, MD^*, and Franz Lehofer, MD

*Department of Anesthesia and General Intensive Care, University of Vienna, Vienna; Department of Anesthesia, DOKH Friesach; and Department of Anesthesia and General Intensive Care, LKH Klagenfurt, Austria

Address correspondence and reprint requests to Stephan Kapral, MD, Department of Anesthesia and General Intensive Care, University of Vienna, 18-20 Waehringer Guertel, A-1090 Vienna, Austria. Address e-mail to Stephan.Kapral{at}univie.ac.at

After institutional approval and informed consent, we studied the effect of epidural bupivacaine 0.5% on visceral perfusion and metabolism by using gastric mucosal tonometry in 30 patients in a placebo-controlled fashion. The maximal intramucosal pH (pHi) decrease was significantly (P < 0.001) greater in the control group (0.16 ± 0.04) than in the thoracic epidural anesthesia (TEA) group (0.07 ± 0.05). There were 10 patients in the control group and 2 patients in the TEA group who had evidence of gastric mucosal ischemia (pHi <7.32) at the end of the study (P< 0.01). The differences in pHi and intramucosal CO₂ (PiCO₂) became statistically significant between the groups after 180 and 240 min. The study data show that TEA prevents the decrease of pHi during major abdominal surgery, perhaps as an effect of stable visceral perfusion. We conclude that TEA may be a valuable method for intra- and postoperative treatment of surgical stress.

Implications: The present study shows that thoracic epidural anesthesia prevents a decrease of intramucosal pH during major abdominal surgery, which suggests that thoracic epidural anesthesia may be a valuable tool for the treatment of surgical stress.

This article has been cited by other articles:

				H. L.A. van den Oever, M. Dzoljic, C. Ince, M. W. Hollmann, and F. C. Mokken Orthogonal polarization spectral imaging of the microcirculation during acute hypervolemic hemodilution and epidural lidocaine injection. Anesth. Analg., August 1, 2006; 103(2): 484 - 7, table of contents. [Abstract] [Full Text] [PDF]

				S. Kosugi, H. Morisaki, T. Satoh, K. Ai, M. Yamamoto, J. Soejima, R. Serita, Y. Kotake, A. Ishizaka, and J. Takeda Epidural Analgesia Prevents Endotoxin-Induced Gut Mucosal Injury in Rabbits Anesth. Analg., July 1, 2005; 101(1): 265 - 272. [Abstract] [Full Text] [PDF]

				G. Djaiani, L. Fedorko, and W. S. Beattie Regional Anesthesia in Cardiac Surgery: A Friend or A Foe? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 87 - 104. [Abstract] [PDF]

				H. Freise, S. Anthonsen, L. G. Fischer, H. K. Van Aken, and A. W. Sielenkamper Continuous Thoracic Epidural Anesthesia Induces Segmental Sympathetic Block in the Awake Rat Anesth. Analg., January 1, 2005; 100(1): 255 - 262. [Abstract] [Full Text] [PDF]

				B. Kabon, E. Fleischmann, T. Treschan, A. Taguchi, S. Kapral, and A. Kurz Thoracic Epidural Anesthesia Increases Tissue Oxygenation During Major Abdominal Surgery Anesth. Analg., December 1, 2003; 97(6): 1812 - 1817. [Abstract] [Full Text] [PDF]

				K. Nandate, M. Ogata, M. Nishimura, T. Katsuki, S. Kusuda, K. Okamoto, N. Nagata, and A. Shigematsu The Difference Between Intramural and Arterial Partial Pressure of Carbon Dioxide Increases Significantly During Laparoscopic Cholecystectomy: The Effect of Thoracic Epidural Anesthesia Anesth. Analg., December 1, 2003; 97(6): 1818 - 1823. [Abstract] [Full Text] [PDF]

				D. A. Vagts, T. Iber, B. Szabo, J. Haberstroh, K. Reising, M. Puccini, K. Geiger, and G. F. E. Noldge-Schomburg Effects of epidural anaesthesia on intestinal oxygenation in pigs Br. J. Anaesth., February 1, 2003; 90(2): 212 - 220. [Abstract] [Full Text] [PDF]

				F. Jin and F. Chung Minimizing perioperative adverse events in the elderly{dagger} Br. J. Anaesth., October 1, 2001; 87(4): 608 - 624. [Abstract] [Full Text] [PDF]