Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis

Demi̇rağ, A; Pastor, Catherine M.; Morel, Philippe; Jean-Christophe, Copin; Sielenkämper, Andreas W.; Güvener, Nilgün; Mai, Gang; Berney, Thierry; Frossard, Jean‐Louis; Bühler, L.

doi:10.3748/wjg.v12.i6.915

Cited by 41 publications

(26 citation statements)

References 32 publications

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“…These findings are in parallel with the literature. 6,24,25 In contrast to some studies from literature, 5,8,9,11 our study showed that the combination of epidural and inhalation anesthesia combination is the ideal anesthesia technique in flap microcirculation. 2,3,6,8 Although there is no statistically significant difference in numbers of rolling, sticking, and transmigrating leukocytes and functional capillary perfusion, this group (group IV) had better flow hemodynamics in the peripheral microcirculation when compared with the inhalation anesthesia group (group I).…”

Section: Discussioncontrasting

confidence: 85%

Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation

et al. 2009

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Section: Discussioncontrasting

confidence: 85%

Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation

et al. 2009

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“…Park et al found recently, when comparing arterial lactate levels in patients undergoing total knee arthroplasty having sevoflurane or spinal anesthesia, a higher lactate increase during sevoflurane anesthesia, thus suggesting a lower production of ischemic metabolites in the spinal anesthesia group [ 32 ]. Improved microcirculation during organ inflammation has been indicated in an experimental rat model using epidural anesthesia [ 33 ]. A positive effect on the tissue perfusion by neuraxial block may modulate the inflammatory response during ischemia/reperfusion.…”

Section: Discussionmentioning

confidence: 99%

No Signs of Inflammation during Knee Surgery with Ischemia: A Study Involving Inhaled Nitric Oxide

Hållström

Frostell

Herrlin

et al. 2014

Mediators of Inflammation

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Nitric oxide donors and inhaled nitric oxide (iNO) may decrease ischemia/reperfusion injury as reported in animal and human models. We investigated whether the attenuation of reperfusion injury, seen by others, in patients undergoing knee arthroplasty could be reproduced when patients had spinal anesthesia. 45 consecutive patients were randomized into three groups (n = 15). Groups 1 and 3 were receiving iNO 80 ppm or placebo (nitrogen, N2) throughout the entire operation, and group 2 only received iNO in the beginning and at the end of the operation. Blood samples were collected before surgery, at the end of the surgery, and 2 hours postoperatively. Muscle biopsies were taken from quadriceps femoris muscle before and after ischemia. There were no increases in plasma levels of soluble adhesion molecules: ICAM, VCAM, P-selectin, E-selectin, or of HMGB1, in any of the groups. There were low numbers of CD68+ macrophages and of endothelial cells expression of ICAM, VCAM, and P-selectin in the muscle analyzed by immunohistochemistry, prior to and after ischemia. No signs of endothelial cell activation or inflammatory response neither systemically nor locally could be detected. The absence of inflammatory response questions this model of ischemia/reperfusion, but may also be related to the choice of anesthetic method EudraCTnr.

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“…In 2006, Demirag et al [ 23 ] showed for the first time the benefit of TEA on the severity of AP in rats. The authors evaluated the impact of TEA during AP by measuring the pancreatic microcirculatory flow and arterial blood gases, and completed the experiment with histological analyses to investigate the development of pancreatic necrosis.…”

Section: Introductionmentioning

confidence: 99%

Thoracic epidural analgesia: a new approach for the treatment of acute pancreatitis?

et al. 2016

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This review article analyzes, through a nonsystematic approach, the pathophysiology of acute pancreatitis (AP) with a focus on the effects of thoracic epidural analgesia (TEA) on the disease. The benefit–risk balance is also discussed. AP has an overall mortality of 1 %, increasing to 30 % in its severe form. The systemic inflammation induces a strong activation of the sympathetic system, with a decrease in the blood flow supply to the gastrointestinal system that can lead to the development of pancreatic necrosis. The current treatment for severe AP is symptomatic and tries to correct the systemic inflammatory response syndrome or the multiorgan dysfunction. Besides the removal of gallstones in biliary pancreatitis, no satisfactory causal treatment exists. TEA is widely used, mainly for its analgesic effect. TEA also induces a targeted sympathectomy in the anesthetized region, which results in splanchnic vasodilatation and an improvement in local microcirculation. Increasing evidence shows benefits of TEA in animal AP: improved splanchnic and pancreatic perfusion, improved pancreatic microcirculation, reduced liver damage, and significantly reduced mortality. Until now, only few clinical studies have been performed on the use of TEA during AP with few available data regarding the effect of TEA on the splanchnic perfusion. Increasing evidence suggests that TEA is a safe procedure and could appear as a new treatment approach for human AP, based on the significant benefits observed in animal studies and safety of use for human. Further clinical studies are required to confirm the clinical benefits observed in animal studies.

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Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis

Abstract: To investigate the effect of epidural anaesthesia (EA) on pancreatic microcirculation during acute pancreatitis (AP)

Cited by 41 publications

References 32 publications

Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation

Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation

No Signs of Inflammation during Knee Surgery with Ischemia: A Study Involving Inhaled Nitric Oxide

Thoracic epidural analgesia: a new approach for the treatment of acute pancreatitis?

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