Details

Autor(en) / Beteiligte

• Tavy, A. L. M.
• de Bruin, A. F. J.
• van der Sloot, K.
• Boerma, E. C.
• Ince, C.
• Noordzij, P. G.
• Boerma, D.
• van Iterson, M.

Titel

Effects of Thoracic Epidural Anaesthesia on the Serosal Microcirculation of the Human Small Intestine

Ist Teil von

• World journal of surgery, 2018-12, Vol.42 (12), p.3911-3917

Ort / Verlag

Cham: Springer International Publishing

Erscheinungsjahr

2018

Quelle

Wiley Online Library Journals Frontfile Complete

Beschreibungen/Notizen

• Background The effect of thoracic epidural analgesia (TEA) on splanchnic blood flow during abdominal surgery remains unclear. The purpose of this study was to examine whether the hemodynamic effects of TEA resulted in microcirculatory alterations to the intestinal serosa, which was visualized using incident dark-field (IDF) videomicroscopy. Methods An observational cohort study was performed. In 18 patients, the microcirculation of the intestinal serosa was visualized with IDF. Microcirculatory and hemodynamic measurements were performed prior to (T1) and after administering a bolus of levobupivacaine (T2). If correction of blood pressure was indicated, a third measurement was performed (T3). The following microcirculatory parameters were calculated: microvascular flow index, proportion of perfused vessels, perfused vessel density and total vessel density. Data are presented as median [IQR]. Results Mean arterial pressure decreased from 73 mmHg (68–83) at T1 to 63 mmHg (±11) at T2 ( p  = 0.001) with a systolic blood pressure of 114 mmHg (98–128) and 87 (81–97), respectively ( p  = 0.001). The microcirculatory parameters of the bowel serosa, however, were unaltered. In seven patients, blood pressure was corrected to baseline values from a MAP of 56 mmHg (55–57), while microcirculatory parameters remained constant. Conclusion We examined the effects of TEA on the intestinal serosal microcirculation during abdominal surgery using IDF imaging for the first time in patients. Regardless of a marked decrease in hemodynamics, microcirculatory parameters of the bowel serosa were not significantly affected. Trial registry number ClinicalTrials.gov identifier NCT02688946.