The effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion on gastric tube blood flow during esophagectomy.
BACKGROUND
Gastric tube necrosis is a major cause of anastomotic leak after esophagectomy. A correlation has been shown between reduced flux at the anastomotic end of the gastric tube and anastomotic leaks.


METHODS
We prospectively studied the effect of intraoperative thoracic epidural bupivacaine and subsequent adrenaline infusion on hemodynamics and flux in the gastric tube.


RESULTS
Administering the epidural bolus significantly decreased flux at the anastomotic end of the gastric tube (P < 0.01). Gastric flux was returned to baseline by an adrenaline infusion.


CONCLUSIONS
The administration of a thoracic epidural bolus may decrease flux at the anastomotic end of the gastric tube.
Al-Rawi
Omar Y
OY
Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK.
Pennefather
Stephen H
SH
Page
Richard D
RD
Dave
Ishani
I
Russell
Glen N
GN
D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage*; D002302:Cardiac Output / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007268:Injections, Epidural; D007430:Intraoperative Care; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D017078:Laser-Doppler Flowmetry; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D013270:Stomach / Q000098:blood supply* / Q000601:surgery; D019738:Surgically-Created Structures / Q000098:blood supply*; D013904:Thoracic Vertebrae; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine