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Published in:

01-11-2004 | Editorial

Epidural analgesia in sepsis: too early to judge a new concept

Authors: Andreas W. Sielenkämper, Hugo Van Aken

Published in: Intensive Care Medicine | Issue 11/2004

Excerpt

Epidural catheters are commonly placed in patients who undergo thoracic or abdominal surgery. In addition to excellent analgesia, epidural infusion of local anaesthetics is associated with a sympathetic block that protects, to some degree, against complications related to surgery and the surgical stress response. These protective effects include increased gastrointestinal blood flow [1], improved tissue oxygenation [2] and a lower incidence of myocardial infarction [3]. In addition, recovery time from surgery is reduced [4]. Because benefits from epidural analgesia are maximal when this technique is used for a prolonged period after surgery, it is recommended to continue epidural analgesia for some days postoperatively. For this reason, intensive care physicians are increasingly confronted with the postoperative use of epidural analgesia, and many have already learned to incorporate this technique into therapeutic strategies to treat critically ill patients. Examples are the prevention or therapy of myocardial ischemia, ileus or splanchnic ischemia, or respiratory dysfunction. …

Kapral S, Gollmann G, Bachmann D, Prohaska B, Likar R, Jandrasits O, Weinstabl C, Lehofer F (1999) The effects of thoracic epidural anesthesia on intraoperative visceral perfusion and metabolism. Anesth Analg 88:402–406CrossRefPubMed

Buggy DJ, Doherty WL, Hart EM, Pallett EJ (2002) Postoperative wound oxygen tension with epidural or intravenous analgesia: a prospective, randomized, single-blind clinical trial. Anesthesiology 97:952–958CrossRefPubMed

Beattie WS, Badner NH, Choi P (2001) Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 93:853–858CrossRefPubMed

Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, Buerkle H, Harks A, Kehlet H (2001) Multimodal perioperative management—combining thoracic epidural analgesia, forced mobilization and oral nutrition—reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg 92:1594–1600PubMed

Adolphs J, Schmidt DK, Korsukewitz I, Kamin B, Habazettl H, Schäfer M, Welte M (2004) Effects of thoracic epidural anesthesia on intestinal microvascular perfusion during normotensive endotoxemia in rats. Intensive Care Med 30:XX

Vallet B (2002) The gut in sepsis. In: Vincent JL, Carlet J, Opal SM (eds) The sepsis text. Kluwer, Boston Dordrecht London, pp 645–664

Sielenkämper AW, Eicker K, Van Aken H (2000) Thoracic epidural anesthesia increases mucosal perfusion in ileum of rats. Anesthesiology 93:844–851CrossRefPubMed

Adolphs J, Schmidt DK, Mousa SA, Kamin B, Korsukewitz I, Habazettl H, Schafer M, Welte M (2003) Thoracic epidural anesthesia attenuates hemorrhage-induced impairment of intestinal perfusion in rats. Anesthesiology 99:685–692CrossRefPubMed

Lazar G, Kaszaki J, Abraham S, Horvath G, Wolfard A, Szentpali K, Paszt A, Balogh A, Boros M (2003) Thoracic epidural anesthesia improves the gastric microcirculation during experimental gastric tube formation. Surgery 134:799–805CrossRefPubMed

10.

Price S, Mitchell JA, Anning PB, Evans TW (2003) Type II nitric oxide synthase activity is cardio-protective in experimental sepsis. Eur J Pharmacol 472:111–118CrossRefPubMed

11.

Cheng X, Leung SW, Lo LS, Pang CC (2003) Selective versus non-selective suppression of nitric oxide synthase on regional hemodynamics in rats with or without LPS-induced endotoxemia. Naunyn Schmiedebergs Arch Pharmacol 367:372–379PubMed

12.

Secchi A, Ortanderl JM, Schmidt W, Walther A, Gebhard MM, Martin E, Schmidt H (2001) Effects of dobutamine and dopexamine on hepatic micro- and macrocirculation during experimental endotoxemia: an intravital microscopic study in the rat. Crit Care Med 29:597–600CrossRefPubMed

13.

Hogan QH, Stekiel TA, Stadnicka A, Bosnjak ZJ, Kampine JP (1995) Region of epidural blockade determines sympathetic and mesenteric capacitance effects in rabbits. Anesthesiology 83:604–610CrossRefPubMed

14.

Freise H, Anthonsen S, Fischer LG, Van Aken H, Sielenkämper AW (2004) Continuous thoracic epidural anesthesia induces segmental sympathetic block in the awake rat. Anesth Analg: (in press)

15.

Ai K, Kotake Y, Satoh T, Serita R, Takeda J, Morisaki H (2001) Epidural anesthesia retards intestinal acidosis and reduces portal vein endotoxin concentrations during progressive hypoxia in rabbits. Anesthesiology 94:263–269CrossRefPubMed

16.

Spackman DR, McLeod AD, Prineas SN, Leach RM, Reynolds F (2000) Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine. Intensive Care Med 26:1638–1645CrossRefPubMed

17.

Hollmann MW, Kurz K, Herroeder S, Struemper D, Hahnenkamp K, Berkelmans NS, den Bakker CG, Durieux ME (2003) The effects of S(-)-, R(+)- and racemic bupivacaine on lysophosphatide-induced priming of human neutrophils. Anesth Analg 97:1053–1058CrossRefPubMed

18.

Hahnenkamp K, Nollet J, Strumper D, Halene T, Rathman P, Mortier E, Van Aken H, Knapp J, Durieux ME, Hoenemann CW (2004) Bupivacaine inhibits thromboxane A2-induced vasoconstriction in rat thoracic aorta. Anesth Analg 99:97–102CrossRefPubMed

Title: Epidural analgesia in sepsis: too early to judge a new concept
Authors: Andreas W. Sielenkämper
Hugo Van Aken
Publication date: 01-11-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2447-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Epidural analgesia in sepsis: too early to judge a new concept

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

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