The effects of thoracic epidural anesthesia on intraoperative visceral perfusion and metabolism.
After institutional approval and informed consent, we studied the effect of epidural bupivacaine 0.5% on visceral perfusion and metabolism by using gastric mucosal tonometry in 30 patients in a placebo-controlled fashion. The maximal intramucosal pH (pHi) decrease was significantly (P < 0.001) greater in the control group (0.16 +/- 0.04) than in the thoracic epidural anesthesia (TEA) group (0.07 +/- 0.05). There were 10 patients in the control group and 2 patients in the TEA group who had evidence of gastric mucosal ischemia (pHi <7.32) at the end of the study (P< 0.01). The differences in pHi and intramucosal CO2 (PiCO2) became statistically significant between the groups after 180 and 240 min. The study data show that TEA prevents the decrease of pHi during major abdominal surgery, perhaps as an effect of stable visceral perfusion. We conclude that TEA may be a valuable method for intra- and postoperative treatment of surgical stress.


CONCLUSIONS
The present study shows that thoracic epidural anesthesia prevents a decrease of intramucosal pH during major abdominal surgery, which suggests that thoracic epidural anesthesia may be a valuable tool for the treatment of surgical stress.
Kapral
S
S
Department of Anesthesia and General Intensive Care, University of Vienna, Austria. Stephan.Kapral@univie.ac.at
Gollmann
G
G
Bachmann
D
D
Prohaska
B
B
Likar
R
R
Jandrasits
O
O
Weinstabl
C
C
Lehofer
F
F
D000005:Abdomen / Q000601:surgery; D000767:Anesthesia, Epidural / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage*; D002245:Carbon Dioxide / Q000378:metabolism; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007511:Ischemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood; D010919:Placebos; D011312:Pressure; D012039:Regional Blood Flow / Q000187:drug effects; D013312:Stress, Physiological / Q000378:metabolism / Q000503:physiopathology; D013904:Thoracic Vertebrae