title: The effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion on gastric tube blood flow during esophagectomy.
abstract: 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.
authors.affiliation: Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK.
authors.forename: Omar Y
authors.initials: OY
authors.lastname: Al-Rawi
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Pennefather
authors.forename: Richard D
authors.initials: RD
authors.lastname: Page
authors.forename: Ishani
authors.initials: I
authors.lastname: Dave
authors.forename: Glen N
authors.initials: GN
authors.lastname: Russell
mesh_terms: 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*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine