Thoracic epidural anesthesia decreases endotoxin-induced endothelial injury.
BACKGROUND
The sympathetic nervous system is considered to modulate the endotoxin-induced activation of immune cells. Here we investigate whether thoracic epidural anesthesia with its regional symapathetic blocking effect alters endotoxin-induced leukocyte-endothelium activation and interaction with subsequent endothelial injury.


METHODS
Sprague Dawley rats were anesthetized, cannulated and hemodynamically monitored. E. coli lipopolysaccharide (Serotype 0127:B8, 1.5 mg x kg(-1) x h(-1)) or isotonic saline (controls) was infused for 300 minutes. An epidural catheter was inserted for continuous application of lidocaine or normal saline in endotoxemic animals and saline in controls. After 300 minutes we measured catecholamine and cytokine plasma concentrations, adhesion molecule expression, leukocyte adhesion, and intestinal tissue edema.


RESULTS
In endotoxemic animals with epidural saline, LPS significantly increased the interleukin-1β plasma concentration (48%), the expression of endothelial adhesion molecules E-selectin (34%) and ICAM-1 (42%), and the number of adherent leukocytes (40%) with an increase in intestinal myeloperoxidase activity (26%) and tissue edema (75%) when compared to healthy controls. In endotoxemic animals with epidural infusion of lidocaine the values were similar to those in control animals, while epinephrine plasma concentration was 32% lower compared to endotoxemic animals with epidural saline.


CONCLUSIONS
Thoracic epidural anesthesia attenuated the endotoxin-induced increase of IL-1β concentration, adhesion molecule expression and leukocyte-adhesion with subsequent endothelial injury. A potential mechanism is the reduction in the plasma concentration of epinephrine.
Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin 12203, Germany.
Fabian
F
Enigk
Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin 12203, Germany.
Antje
A
Wagner
Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
Rudi
R
Samapati
Department of Anesthesia and Critical Care, Josef-Schneider-Straße 2, 97080 Würzburg, Germany.
Heike
H
Rittner
Department of Anesthesia and Critical Care, Josef-Schneider-Straße 2, 97080 Würzburg, Germany.
Alexander
A
Brack
Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany.
Shaaban A
SA
Mousa
Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany.
Michael
M
Schäfer
Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany ; Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany.
Helmut
H
Habazettl
Department of Anesthesiology, Emergency Medicine and Critical Care Medicine, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, Göttingen 37099, Germany.
Jörn
J
Schäper
D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000494:pharmacology; D000818:Animals; D002448:Cell Adhesion / Q000187:drug effects; D016207:Cytokines / Q000378:metabolism; D019040:E-Selectin / Q000378:metabolism; D042783:Endothelial Cells / Q000187:drug effects* / Q000473:pathology; D019446:Endotoxemia / Q000188:drug therapy; D004731:Endotoxins / Q000633:toxicity; D004926:Escherichia coli / Q000378:metabolism; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D053583:Interleukin-1beta / Q000097:blood; D007962:Leukocytes / Q000378:metabolism; D008012:Lidocaine / Q000008:administration & dosage* / Q000494:pharmacology; D008070:Lipopolysaccharides / Q000633:toxicity; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley
D000779:Anesthetics, Local; D016207:Cytokines; D019040:E-Selectin; D004731:Endotoxins; D053583:Interleukin-1beta; D008070:Lipopolysaccharides; D018799:Intercellular Adhesion Molecule-1; D008012:Lidocaine
Adhesion molecules; Cytokines; Endothelial injury; Endotoxemia; Epidural anesthesia; Lidocaine; Myeloperoxidase