title: Thoracic epidural anesthesia attenuates hemorrhage-induced impairment of intestinal perfusion in rats.
abstract: BACKGROUND
  During hemorrhagic hypotension, sympathetic vasoconstriction crucially contributes to gut mucosal damage. Sympathetic blockade by thoracic epidural anesthesia has been shown to increase mucosal microvascular perfusion and to improve survival after severe hemorrhage in laboratory animals. This study investigates the effects of thoracic epidural anesthesia on intestinal microvascular perfusion during hemorrhagic hypotension in rats.
  
  
  METHODS
  In 32 anesthetized Sprague-Dawley rats either lidocaine 2% (thoracic epidural anesthesia) or normal saline (control) was infused via thoracic epidural catheters. Hemorrhagic hypotension (mean arterial pressure 30 mmHg for 60 min) was induced by withdrawal of blood, which was subsequently retransfused for resuscitation. Functional capillary density and erythrocyte velocity in the mucosa and muscularis were determined by intravital microscopy. Leukocyte-endothelium interaction was studied in postcapillary venules and sympathetic nerve fibers of the intestinal wall were identified by immunohistochemistry.
  
  
  RESULTS
  During hypotension functional capillary density was significantly (P < 0.001) lower in the muscularis of the control group (median [25/75 percentile]: -46.5% [-59.6/-20.8%] change from baseline) as compared with animals that received thoracic epidural anesthesia (-6.1% [-13.4/1.1%]). There were no differences in erythrocyte velocity between groups throughout the experiment. Leukocyte rolling increased significantly (P < 0.001) after resuscitation in control (12 [6/15] vs. baseline 2.5 [1/8]) but not in thoracic epidural anesthesia (4 [2.3/7] vs. baseline: 5 [3/15.5]). Sympathetic nerve fibers were identified in the muscularis and submucosa but not in the mucosa.
  
  
  CONCLUSIONS
  During hemorrhagic hypotension and after resuscitation, thoracic epidural anesthesia has beneficial effects on intestinal microvascular perfusion. Because of blockade of sympathetic nerves, thoracic epidural anesthesia prevents perfusion impairment of the muscularis during hypotension and attenuates leukocyte rolling after resuscitation.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Freie Universität Berlin, Germany. joern_adolphs@web.de
authors.forename: Jörn
authors.initials: J
authors.lastname: Adolphs
authors.forename: Diego K
authors.initials: DK
authors.lastname: Schmidt
authors.forename: Shaaban A
authors.initials: SA
authors.lastname: Mousa
authors.forename: Britta
authors.initials: B
authors.lastname: Kamin
authors.forename: Ines
authors.initials: I
authors.lastname: Korsukewitz
authors.forename: Helmut
authors.initials: H
authors.lastname: Habazettl
authors.forename: Michael
authors.initials: M
authors.lastname: Schäfer
authors.forename: Martin
authors.initials: M
authors.lastname: Welte
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects / Q000502:physiology; D000320:Adrenergic Fibers / Q000502:physiology; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D000818:Animals; D004730:Endothelium, Vascular / Q000166:cytology / Q000502:physiology; D006470:Hemorrhage / Q000503:physiopathology*; D007082:Ileum / Q000098:blood supply / Q000187:drug effects / Q000294:innervation; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000098:blood supply / Q000187:drug effects / Q000294:innervation; D007422:Intestines / Q000098:blood supply* / Q000294:innervation / Q000502:physiology; D007962:Leukocytes / Q000502:physiology; D008012:Lidocaine / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D010477:Perfusion; D051381:Rats; D017207:Rats, Sprague-Dawley; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D013564:Sympathetic Nervous System / Q000502:physiology
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine