title: Thoracic epidural anesthesia improves the gastric microcirculation during experimental gastric tube formation.
abstract: BACKGROUND
  Gastric tube formation is a surgical technique to reestablish the continuity of the gastrointestinal tract after esophagectomy. Our aims were to study the microcirculatory consequences of experimental gastric tube formation and characterize the effects of thoracic epidural anesthesia (TEA) during this condition.
  
  
  METHODS
  The experiments were performed on mongrel dogs anesthetized with pentobarbital. The stomach was prepared for replacement according to the method of Akiyama, and TEA was induced with bupivacaine (1 mg/kg). Macrohemodynamics, intramucosal pH, and gastric motility changes were monitored, and intravital video-microscopy with orthogonal polarization spectral imaging technique was used to observe the gastric microcirculation.
  
  
  RESULTS
  The gastric pull-up induced a significant decrease in intramucosal pH. The functional capillary density of the mucosa or subserosa did not change; the red blood cell velocity in the capillaries of the upper part of the gastric tube was decreased in the mucosa, as well as on the serosal side. After epidural anesthesia the red blood cell velocity returned to the baseline, and the gastric and intestinal motility index was significantly increased.
  
  
  CONCLUSIONS
  TEA significantly improves the microcirculation of the distal portion of the gastric tube and increases the intestinal and gastric motility after gastric pull-up. The procedure is favorable and should be recommended during reconstructive esophageal surgery.
authors.affiliation: Department of Surgery, and the Institute of Surgical Research, Szent-Györgyi Albert Medical Center, University of Szeged, PO Box 464, H-6701 Szeged, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Lázár
authors.forename: József
authors.initials: J
authors.lastname: Kaszaki
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Abrahám
authors.forename: Gábor
authors.initials: G
authors.lastname: Horváth
authors.forename: Antal
authors.initials: A
authors.lastname: Wolfárd
authors.forename: Károly
authors.initials: K
authors.lastname: Szentpáli
authors.forename: Attila
authors.initials: A
authors.lastname: Paszt
authors.forename: Adám
authors.initials: A
authors.lastname: Balogh
authors.forename: Mihály
authors.initials: M
authors.lastname: Boros
mesh_terms: D000767:Anesthesia, Epidural; D000818:Animals; D004285:Dogs; D016629:Esophagectomy; D005753:Gastric Mucosa / Q000098:blood supply*; D005769:Gastrointestinal Motility; D008833:Microcirculation; D013270:Stomach / Q000601:surgery*