Intestinal effects of thoracic epidural anesthesia.
OBJECTIVE
Thoracic epidural anesthesia (TEA) is most frequently used after major surgery. However, despite ongoing research, the influence of TEA on the intestinal perioperative pathophysiology is not fully understood.


RESULTS
According to recent results, the splanchnic sympathetic activity is reduced during TEA both in animal models and in clinical TEA. The splanchnic sympathetic activity during high TEA is still unknown. Intestinal perfusion effects of TEA are still unclear as the technique and extent of TEA, hemodynamic alteration and size of measurement result in--seemingly--conflicting reports. Postoperative ileus after laparotomy is ameliorated by TEA. Recent findings suggest beneficial effects also after major laparoscopic procedures. Finally, the impact of TEA on the intestinal pathophysiology in critical illness is an area of growing clinical and scientific interest, although this knowledge is just at its beginning.


CONCLUSIONS
Further research concerning the use of TEA in major laparoscopic procedures and its potential to improve or endanger anastomotic healing is warranted. The experimental studies of TEA in critical illness should be expanded.
Freise
Hendrik
H
Department of Anesthesiology and Intensive Care, University Hospital Muenster, Muenster, Germany. freiseh@uni-muenster.de
Fischer
Lars G
LG
D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000818:Animals; D001340:Autonomic Nerve Block / Q000009:adverse effects*; D016638:Critical Illness; D016145:Endoscopy, Digestive System / Q000379:methods*; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007422:Intestines / Q000098:blood supply / Q000503:physiopathology*; D013153:Splanchnic Nerves / Q000502:physiology; D013904:Thoracic Vertebrae