title: Neuraxial Anesthesia Reduces Lymphatic Flow: Proof-of-Concept in First In-Human Study.
abstract: Dilation of lymphatic vessels may contribute to iatrogenic dissemination of cancer cells during surgery. We sought to determine whether neuraxial anesthesia reduces regional lymphatic flow. Using nuclear lymphoscintigraphy, 5 participants receiving spinal anesthesia for brachytherapy had lower extremity lymph flow at rest compared with flow under conditions of spinal anesthesia. Six limbs were analyzed. Four limbs were excluded because of failure to demonstrate lymph flow (1 patient, 2 limbs), colloid injection error (1 limb), and undiagnosed deep vein thrombosis (1 limb). All analyzed limbs showed reduced lymph flow washout from the pedal injection site (range 62%-100%) due to neuraxial anesthesia. Lymph flow was abolished in 3 limbs. We report proof-of-concept that neuraxial anesthesia reduces lymphatic flow through a likely mechanism of sympathectomy.
authors.affiliation: From the *Department of Cancer Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Australia; †Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; ‡PhD candidate, Monash University, Clayton, Melbourne, Australia; §Department of Diagnostic Imaging, Peter MacCallum Cancer Centre, Australia; ‖Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; ¶Department of Obstetrics and Gynaecology, University of Melbourne, Australia; and #Department of Nuclear Imaging and PET, Monash Medical Centre, Australia.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Hiller
authors.forename: Hilmy M
authors.initials: HM
authors.lastname: Ismail
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hofman
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
authors.forename: Shakher
authors.initials: S
authors.lastname: Ramdave
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Riedel
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000639:trends*; D001918:Brachytherapy / Q000379:methods; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000502:physiology; D008196:Lymph / Q000187:drug effects / Q000502:physiology*; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008875:Middle Aged