Abstract
Hepatic hypoperfusion is regarded as an important factor in the pathophysiology of perioperative liver injury. Although thoracic epidural anesthesia is a widely used technique, limited data are available about the effects on hepatic blood flow with blockade restricted to thoracic segments in humans. The main objective of the present study was to investigate the effects of thoracic epidural anesthesia on hepatic blood flow under general anesthesia in humans. In 40 patients under general anesthesia, we assessed hepatic blood flow using plasma disappearance rate of indocyanine green (PDRICG) as a simple noninvasive method before and after induction of thoracic epidural anesthesia. The epidural catheter was inserted at the Th7/8 or Th8/9, and 1% lidocaine at a mean (range) dose of 8 (6-10) mL was injected. Ephedrine bolus was given to patients who demonstrated a decrease in mean arterial blood pressure below 60 mm Hg after induction of thoracic epidural anesthesia (TEA-E group). Other patients did not receive any catecholamines during the study period (TEA group). Ten patients who did not undergo TEA served as controls (control group). In 7 patients, administration of ephedrine was necessary to avoid a decrease in mean arterial blood pressure below 60 mm Hg. Thus, the TEA-E group consisted of 7 patients and TEA group of 33. In the TEA group, thoracic epidural anesthesia was associated with a mean 2.3% min(-1) decrease in PDRICG (P<0.05). In the TEA-E group, all seven patients showed a 2.2% min(-1) decrease in PDRICG (P<0.05). Patients in the control group showed a mean 1.1% min(-1) increase in PDRICG (P<0.05). In contrast to hepatic blood flow, cardiac output was not affected by thoracic epidural anesthesia. In humans, thoracic epidural anesthesia is associated with a decrease in hepatic blood flow. Thoracic epidural anesthesia combined with ephedrine bolus was found to result in further decrease in hepatic blood flow.
Highlights
Patients undergoing major abdominal surgery are at risk of developing postoperative complications including multiple organ failure
In contrast to hepatic blood flow, cardiac output was not affected by thoracic epidural anesthesia
Thoracic epidural anesthesia is associated with a decrease in hepatic blood flow
Summary
Patients undergoing major abdominal surgery are at risk of developing postoperative complications including multiple organ failure. There have been discussions about whether or not thoracic epidural anesthesia (TEA) is able to reduce perioperative risk. Thoracic epidural anesthesia and analgesia is widely used technique, the effects on hepatic blood flow with blockade restricted to thoracic segments have not been investigated extensively. TEA may induce different physiological reactions with conflicting effects on hepatic blood flow. Hypotension as a result of a decreased systemic vascular resistance may reduce hepatic blood flow. Lumbar epidural anesthesia has been shown to induce a decrease in hepatic blood flow in animals [3, 4] and in humans [5, 6]. We hypothesized that thoracic epidural anesthesia maintains hepatic blood flow in humans
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
