Effect of thoracic epidural analgesia on gastric blood flow after oesophagectomy.
BACKGROUND
The oesophagectomy procedure includes the formation of a gastric tube to re-establish the continuity of the gastrointestinal tract. The effect of thoracic epidural analgesia (TEA) on gastric mucosal blood flow (GMBF) remains unknown in clinical practice. The aim of this prospective observational study was to assess the microcirculatory changes induced by TEA in the early post-operative course.


METHODS
Eighteen consecutive patients who underwent radical oesophagectomy with en-bloc resection and two-field lymphadenectomy for oesophageal cancer, and benefited from TEA during the post-operative course, were studied prospectively, and compared with nine patients who declined the use of TEA in the same period (control group). GMBF was measured using a laser Doppler flowmeter in three consecutive time periods (before and after 1 and 18 h of TEA infusion). Post-operative monitoring also included the measurement of arterial pressure, cardiac output, gas exchange and intrathoracic blood volume index.


RESULTS
After the first and 18th hour of infusion, TEA induced an increase in GMBF compared with baseline and the control group. The mean arterial pressure and intrathoracic blood volume index decreased after the first hour of TEA infusion with no influence on the cardiac index.


CONCLUSIONS
This clinical study demonstrates that TEA improves the microcirculation of the gastric tube in the early post-oesophagectomy period. The clinical relevance of TEA in this setting should be validated in larger studies focusing on the clinical outcome following oesophagectomy.
Michelet
P
P
Département d'Anesthésie Réanimation, Hôpitaux Sud, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 9, France. pierre.michelet@ap-hm.fr
Roch
A
A
D'Journo
X-B
XB
Blayac
D
D
Barrau
K
K
Papazian
L
L
Thomas
P
P
Auffray
J-P
JP
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000494:pharmacology; D000704:Analysis of Variance; D016629:Esophagectomy; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D017409:Sufentanil / Q000494:pharmacology; D013909:Thorax; D013997:Time Factors
D000701:Analgesics, Opioid; D017409:Sufentanil