Anesth Analg 2003;97:1812-1817
© 2003 International Anesthesia Research Society
REGIONAL ANESTHESIA
Thoracic Epidural Anesthesia Increases Tissue Oxygenation During Major Abdominal Surgery
Barbara Kabon, MD*,
Edith Fleischmann, MD ,
Tanja Treschan, MD ,
Akiko Taguchi, MD*,
Stephan Kapral, MD , and
Andrea Kurz, MD*, ,||
*Department of Anesthesiology, Washington University, St. Louis, Missouri,
Department of Anesthesiology and General Intensive Care and
Anesthesiology and Intensive Care Medicine, Vienna General Hospital, University of Vienna, Austria;
Department of Anesthesiology, University of Berne, Switzerland; and
||Outcomes Research InstituteTM, University of Louisville, Kentucky
Address correspondence and reprint requests to Andrea Kurz, MD, Department of Anesthesiology, University of Berne, 3010 Berne, Switzerland. Address e-mail to kurza{at}msnotes.wustl.edu
Intraoperative surgical stress may markedly increase adrenergic nerve activity and plasma catecholamine concentrations, which causes peripheral vasoconstriction and decreased tissue oxygen partial pressure possibly leading to tissue hypoxia. Tissue hypoxia is associated with an increased incidence of surgical wound infections. Thoracic epidural anesthesia blocks afferent neural stimuli and inhibits efferent sympathetic outflow in response to painful stimuli. Consequently, we tested the hypothesis that supplemental thoracic epidural anesthesia during major abdominal surgery improves tissue perfusion and subcutaneous oxygen tension. Thirty patients were randomly assigned to two groups: general (n = 15) or combined general and epidural anesthesia (n = 15). Anesthesia technique and fluid management were standardized. Subcutaneous tissue oxygen tension was measured continuously in the upper arm with a Clark type electrode. Data were compared with unpaired, two-tailed t-tests, Wilcoxons ranked sum test, or repeated-measures analysis of variance and Scheffé F tests as appropriate; P < 0.05 was considered statistically significant. After 60 min, intraoperative tissue oxygen tension was significantly larger during combined anesthesia than during general anesthesia (54.3 ± 7.4 mm Hg versus 42.1 ± 8.6 mm Hg; P = 0.0002). Subcutaneous tissue oxygen tension remained significantly higher in the combined general/epidural anesthesia group throughout the observation period. Hemodynamic responses and global oxygen variables were similar in the groups. Thoracic epidural anesthesia improved intraoperative tissue oxygen tension outside the area of the epidural block. Thus, our results give evidence that supplemental neural nociceptive block blunts generalized vasoconstriction caused by surgical stress and adrenergic responses.
IMPLICATIONS: Thoracic epidural anesthesia blunts the decrease of subcutaneous tissue oxygen tension caused by surgical stress and adrenergic vasoconstriction during major abdominal surgery. Consequently, combined general and epidural anesthesia helps to provide sufficient tissue oxygenation.
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