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REGIONAL ANESTHESIA

The Effects of Epidural and General Anesthesia on Tissue Oxygenation

Tanja A. Treschan, MD^*, Akiko Taguchi, MD, Syed Z. Ali, MD, Neeru Sharma, MD, Barbara Kabon, MD^*, Daniel I. Sessler, MD^,¶,#, and Andrea Kurz, MD^,||,¶

*Department of Anesthesia and General Intensive Care, Vienna General Hospital, Ludwig Boltzmann Institute, and Department of Anesthesia and Intensive Care Medicine, University of Vienna, Vienna, Austria; Departments of Anesthesia and ||Anesthesiology, Washington University, St. Louis, Missouri; and ¶Outcomes Research^TM Institute and #Department of Anesthesiology, University of Louisville, Louisville, Kentucky

Address correspondence and reprint requests to Dr. Andrea Kurz, 660 So. Euclid Ave., St. Louis, MO 63110. Address e-mail to kurza{at}msnotes.wustl.edu

The risk of wound infections is inversely related to subcutaneous tissue oxygen tension. General anesthesia increases local blood flow by direct vasodilation and central inhibition of thermoregulatory vasoconstriction. Epidural anesthesia can increase perfusion in blocked regions by decreasing sympathetic tone. We therefore tested the hypothesis that epidural anesthesia increases tissue oxygen tension in awake and anesthetized subjects. Fifteen healthy volunteers underwent epidural, general, and combined epidural and general anesthesia. Subcutaneous tissue oxygen tension was measured using tonometers in the lateral upper arm and the lateral thigh. Epidural anesthesia to a T10 level was maintained with 0.75% mepivacaine. General anesthesia was maintained with 1.5% sevoflurane in 30% oxygen; 30% inspired oxygen was given via a sealed facemask during baseline and epidural anesthesia. Baseline subcutaneous tissue oxygen tensions for arm and thigh were 57 ± 11 and 54 ± 8 mm Hg, respectively. Epidural anesthesia significantly increased tissue oxygenation in the thigh by 9 mm Hg, to 63 ± 7 mm Hg, without increasing arm oxygenation. Tissue oxygenation in the arm and thigh were similar during general anesthesia alone, 58 ± 11 and 63 ± 12 mm Hg. Arm oxygenation remained unchanged with the addition of epidural anesthesia; however, thigh subcutaneous oxygen partial pressure increased 8 ± 3 mm Hg, from 63 ± 12 to 71 ± 9 mm Hg. Although epidural anesthesia increased tissue oxygenation significantly with and without general anesthesia, the magnitude of this increase might be of marginal clinical importance in regard to surgical wound infections.

IMPLICATIONS: Epidural anesthesia significantly increased subcutaneous tissue oxygenation in the thigh both with and without general anesthesia. Although each increase was statistically significant, previous work suggests that the magnitude of these changes is unlikely to markedly reduce the risk of surgical wound infection.

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