RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

Abstract

Purpose: To evaluate the effects of perioperative epidural analgesia on hemodynamics, splanchnic perfusion and regulators of circulation.Methods: Twenty patients undergoing aortic surgery were randomised into two groups: epidural analgesia group (EAG): epidural analgesia with bupivacaine (15 ml, 0.125%) was started before surgery. Eight and 16 hr postoperatively 10 ml bupivacaine 0.125% and 1 mg morphine were given. Control group (COG): patients received no epidural catheter. Monitoring included pulmonary artery catheter and gastric tonometer. Norepinephrine, epinephrine, renin, ADH, ANP and endothelin were measured: before epidural analgesia (T0), before aortic clamping (T1), 20 min after aortic clamping (T2), after declamping the first leg (T3), at end of surgery (T4), one hour (T5) and 24 hr postoperatively (T6).Results: At T5 mean arterial blood pressure decreased in EAG compared with baseline (86 ± 16 to 75 ± 8 mmHg) and compared with COG (75 ± 8 vs 84 ± 11 mmHg). At T2 pulmonary capillary wedge pressure and cardiac index increased and at T6 decreased in both groups. Systemic vascular resistance decreased at T1 and at T3-T5 in EAG compared with COG and at T1 and T3-T6 to baseline (1472 ± 448 to 1027 ± 184 dyn· sec·cm). In EAG and in COG, pHi decreased compared with baseline but without group differences. In both groups, epinephrine, norepinephrine, renin, and ADH levels increased from baseline. Endothelin and ANP levels showed no changes.Conclusions: Perioperatively administrated epidural bupivacaine has no beneficially effects on hemodynamics, pHi or release of regulators of circulation.Objectif : Étudier les effets de l'analgésie péridurale périopératoire sur l'hémodynamie, la perfusion splanchnique et les régulateurs de la circulation.Méthode : Vingt patients subissant un pontage aortique infrarénal ont été répartis au hasard en deux groupes : un groupe GP recevant l'analgésie péridurale avec bupivacaïne (15 ml à 0,125 %) avant l'opération, suivis de 10 ml de bupivacaïne à 0,125 % et de 1 mg de morphine 8 h et 16 h après l'opération; un groupe témoin GT sans cathéter épidural. Le monitorage comprenait un cathéter de l'artère pulmonaire et un tonomètre gastrique. Les régulateurs de circulation étaient mesurés sur des échantillons de sang : avant l'analgésie péridurale (T 0 ), avant le clampage aortique (T 1 ), 20 min après le clampage aortique (T 2 ), après déclampage de l'artère iliaque d'un côté (T 3 ), à la fin de l'opération (T 4 ), 1 h après l'opération (T 5 ) et 24 h après l'opération (T 6 ).Résultats : À T5, la pression artérielle moyenne diminuait dans le GP par rapport aux mesures initiales (86 ± 16 à 75 ± 8 mmHg) et comparé au GT (75 ± 8 vs 84 ± 11 mmHg). À T 2 , la pression capillaire pulmonaire et l'index cardiaque étaient élevés et à T 6 diminués de façon similaire dans les deux groupes. Les résistances vasculaires systémiques diminuaient à T 1 et T 3 -T 5 dans le GP en comparaison avec le GT et à T 1 et T 3 -T 6 par rapport aux mesures initiales (1472 ± 448 à 1027 ± 184 dyn"sec/cm 5"m2. Dans...

Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

“…On the other hand, Piper et al . [18] reported significant difference in MAP before clamping and after release of clamp, with lower values in patients under combined general–epidural anesthesia. Finally, SVR was significantly lower in Group A at T3–T4 compared with T0, whereas in Group B SVR was significantly higher during clamping (T2) compared with T0, highlighting the beneficial effect of epidural anesthesia on sympathetic blockage.…”

“…Piper et al . [18] concluded that perioperatively administration of bupivacaine epidurally has no beneficial effects on hemodynamics or intestinal pH, but in this particular study local anesthetic was administered at bolus doses in constant time intervals.…”

Thromboembolic Risk Assessment and the Efficacy of Enoxaparin Prophylaxis in Excisional Body Contouring Surgery

“…It is believed that there is an increase in both coagulation activation and fibrinolysis but that there is some fundamental change in the balance between the two systems. 31,32 Patients who were taking oral contraceptive pills or hormone replacement therapy were instructed to discontinue use 1 week before surgery. It is interesting to note that this did not decrease the rate of venous thromboembolism in this group to a nonsignificant level.…”

Epidural anesthesia and splanchnic perfusion

“…CO 2 -gap was also comparable between groups. 1 These findings are in disagreement with the majority of studies on the effects of epidural anesthesia on splanchnic perfusion during abdominal surgery. Most studies reported beneficial effects of epidural anesthesia, resulting in increased regional blood flow or gastric pHi.…”