title: Effects of epidural-and-general anesthesia combined versus general anesthesia alone on femoral venous flow during laparoscopic cholecystectomy.
abstract: OBJECTIVE
  The pneumoperitoneum has been shown to decrease femoral blood flow, resulting in venous stasis. We analyzed the effects of the pneumoperitoneum and epidural analgesia on femoral vein diameter and the peak flow rate of femoral vein during laparoscopic cholecystectomy.
  
  
  METHODS
  Forty patients were randomly allocated to receive either combined epidural analgesia (EA) and general anesthesia (GA) (group EA/GA) or GA alone (group GA). Laparoscopic cholecystectomy was the standard operation for the selected patients. Then, 10 mL of 1% lidocaine in group EA/GA or physiologic serum in group GA was injected via epidural catheter. Peak flow rates (PFRs) of femoral vein cross-sectional areas (CSAs) were measured from the right femoral vein at three different times: after induction of anesthesia, during the pneumoperitoneum, and after abdominal deflation, but prior to reversal of anesthesia.
  
  
  RESULTS
  The two groups were similar in age, sex, body mass index, and duration of operation. The CSA slightly increased after the induction of anesthesia, compared with the previous measurements, although there was no statistical significance between them for both groups (P > 0.05). The PFR decreased, whereas the CSA increased during the pneumoperitoneum in each group. The PFR values after basal measurements were significantly higher in the EA/GA than in the GA group (P < 0.05). Group EA/GA had significantly lower heart-rate and blood-pressure levels during surgery than those in group GA (P < 0.05).
  
  
  CONCLUSIONS
  Abdominal insufflation during laparoscopic cholecystectomy results in dilation and decreased flow in the common femoral vein. Epidural analgesia added to the GA partially compensated for the reduction in femoral PFR.
authors.affiliation: Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey. nimetsenoglu@hotmail.com
authors.forename: Nimet
authors.initials: N
authors.lastname: Senoglu
authors.forename: Mehmet F
authors.initials: MF
authors.lastname: Yuzbasioglu
authors.forename: Hafize
authors.initials: H
authors.lastname: Oksuz
authors.forename: Huseyin
authors.initials: H
authors.lastname: Yildiz
authors.forename: Zafer
authors.initials: Z
authors.lastname: Dogan
authors.forename: Ertan
authors.initials: E
authors.lastname: Bulbuloglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Goksu
authors.forename: Gokce
authors.initials: G
authors.lastname: Gisi
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D014664:Vasodilation / Q000502:physiology