title: The influence of epidural blockade on gut permeability in patients undergoing open surgical repair of abdominal aortic aneurysm.
abstract: BACKGROUND
  Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes.
  
  
  METHODS
  Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio.
  
  
  RESULTS
  No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G.
  
  
  CONCLUSIONS
  Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdańsk, Poland. ait@gumed.edu.pl.
authors.forename: Radosław
authors.initials: R
authors.lastname: Owczuk
authors.forename: Anna
authors.initials: A
authors.lastname: Dylczyk-Sommer
authors.forename: Jacek
authors.initials: J
authors.lastname: Wojciechowski
authors.forename: Monika
authors.initials: M
authors.lastname: Paszkiewicz
authors.forename: Maria
authors.initials: M
authors.lastname: Wujtewicz
authors.forename: Piotr
authors.initials: P
authors.lastname: Stepnowski
authors.forename: Paweł
authors.initials: P
authors.lastname: Twardowski
authors.forename: Wioletta
authors.initials: W
authors.lastname: Sawicka
authors.forename: Michał
authors.initials: M
authors.lastname: Domżalski
authors.forename: Magdalena A
authors.initials: MA
authors.lastname: Wujtewicz
mesh_terms: D000368:Aged; D000577:Amides; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D000779:Anesthetics, Local; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007422:Intestines / Q000187:drug effects*; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010539:Permeability / Q000187:drug effects*; D000077212:Ropivacaine; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: anaesthesia; aortic aneurysm; assessment; barrier; epidural blockade; gut; open surgery; regional; repair