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 (5) Citing Articles via Google Scholar Google Scholar Articles by Vagts, D. A. Articles by Nöldge-Schomburg, G. F. E. Search for Related Content PubMed PubMed Citation Articles by Vagts, D. A. Articles by Nöldge-Schomburg, G. F. E. Related Collections Cardiovascular Regional Anesthesia

---

REGIONAL ANESTHESIA

The Effects of Thoracic Epidural Anesthesia on Hepatic Perfusion and Oxygenation in Healthy Pigs During General Anesthesia and Surgical Stress

Dierk A. Vagts, MD DEAA, EDIC^*,, Thomas Iber, MD^*,, Marcus Puccini, MD^*,, Bela Szabo, MD PhD, Jörg Haberstroh, MD PhD, Florian Villinger^*, Klaus Geiger, MD PhD^*, and Gabriele F. E. Nöldge-Schomburg, MD PhD^*,

*Anaesthesiologische Universitätsklinik Freiburg, Freiburg im Breisgau, Germany; Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Rostock, Rostock, Germany; Institut für Experimentelle und Klinische Pharmakologie und Toxikologie der Universität Freiburg, Freiburg im Breisgau, Germany; and Chirurgische Forschung, Chirurgische Universitätsklinik Freiburg, Freiburg im Breisgau, Germany

Address correspondence and reprint requests to Dierk A. Vagts, MD, DEAA, EDIC, Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Rostock, Schillingallee 35, D-18055 Rostock, Germany. Address e-mail to dierk.vagts{at}medizin uni-rostock.de.

Perioperative liver injury due to decreased perfusion may be an underlying mechanism behind the development of systemic inflammatory response syndrome. We designed this animal study to assess whether thoracic epidural anesthesia (TEA) impairs liver oxygenation due to induced hypotension. After ethical approval, 19 anesthetized and acutely instrumented pigs were randomly assigned to 3 groups (control and TEA alone versus TEA plus volume loading). Bupivacaine 0.5% 0.75 mL per segment was injected into the epidural space, aiming for a T5 to T12 block. After baseline values were obtained, measurements were repeated 60 and 120 min after epidural injection. TEA was associated with decreased mean arterial blood pressure but no change in total hepatic blood flow. Oxygen delivery to the liver and oxygen uptake remained unchanged. Liver tissue oxygen partial pressure did not decrease. The plasma indocyanine green disappearance rate remained stable. Volume loading before TEA did not relevantly affect total hepatic blood flow; it even decreased oxygen supply to the liver by hemodilution. We conclude that, despite decreased mean arterial blood pressure, TEA did not affect liver oxygenation. There was no clinically relevant effect of volume loading on total hepatic perfusion.

This article has been cited by other articles:

				R. Meierhenrich, F. Wagner, W. Schutz, M. Rockemann, P. Steffen, U. Senftleben, and A. Gauss The Effects of Thoracic Epidural Anesthesia on Hepatic Blood Flow in Patients Under General Anesthesia Anesth. Analg., April 1, 2009; 108(4): 1331 - 1337. [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]

				Feedback CEACCP, August 1, 2004; 4(4): 132 - 133. [Full Text] [PDF]