title: Phenylephrine infusion improves blood flow to the stomach during oesophagectomy in the presence of a thoracic epidural analgesia.
abstract: OBJECTIVE
  Gastric tube necrosis is a major cause of mortality after oesophagectomy. The construction of the gastric tube used for oesophageal reconstruction involves a division of several arteries leading to a reduction in the blood supply at the fundus, which is used for the oesophageal anastomosis. This study was undertaken to determine the effect of thoracic epidural anaesthesia and intravenous phenylephrine on haemodynamics and blood flow in the tubularized stomach.
  
  
  METHODS
  Ten patients undergoing an oesophagectomy were prospectively studied. Pulmonary artery catheters were used to measure haemodynamic changes, and laser Doppler flow probes were used to measure gastric blood flow. The effects of an intraoperative thoracic epidural and subsequent intravenous phenylephrine infusion were documented.
  
  
  RESULTS
  The administration of a thoracic epidural bolus of bupivacaine 0.25% at 0.1 ml kg resulted in a significant reduction in flux at the anastomotic end of the newly formed gastric tube from a median of 57-41 perfusion units (P = 0.003). A subsequent intravenous phenylephrine infusion titrated to restore mean arterial pressure significantly increased the flux at the anastomotic end from a median of 41-66 perfusion units (P = 0.009).
  
  
  CONCLUSIONS
  An intravenous phenylephrine infusion can reverse the epidural bolus-induced reduction in blood flow at the anastomotic end of the newly formed gastric tube.
authors.affiliation: Department of Anaesthesia, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Darshan
authors.initials: D
authors.lastname: Pathak
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Pennefather
authors.forename: Glenn N
authors.initials: GN
authors.lastname: Russell
authors.forename: Omar
authors.initials: O
authors.lastname: Al Rawi
authors.forename: I C
authors.initials: IC
authors.lastname: Dave
authors.forename: Susan
authors.initials: S
authors.lastname: Gilby
authors.forename: Richard D
authors.initials: RD
authors.lastname: Page
mesh_terms: D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D016629:Esophagectomy; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D017078:Laser-Doppler Flowmetry; D010656:Phenylephrine / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D013270:Stomach / Q000098:blood supply / Q000187:drug effects; D013904:Thoracic Vertebrae; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D002045:Bupivacaine