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01-12-2018 | Original Scientific Report with Video

Effects of Thoracic Epidural Anaesthesia on the Serosal Microcirculation of the Human Small Intestine

Authors: A. L. M. Tavy, A. F. J. de Bruin, K. van der Sloot, E. C. Boerma, C. Ince, P. G. Noordzij, D. Boerma, M. van Iterson

Published in: World Journal of Surgery | Issue 12/2018

Abstract

Background

The effect of thoracic epidural analgesia (TEA) on splanchnic blood flow during abdominal surgery remains unclear. The purpose of this study was to examine whether the hemodynamic effects of TEA resulted in microcirculatory alterations to the intestinal serosa, which was visualized using incident dark-field (IDF) videomicroscopy.

Methods

An observational cohort study was performed. In 18 patients, the microcirculation of the intestinal serosa was visualized with IDF. Microcirculatory and hemodynamic measurements were performed prior to (T1) and after administering a bolus of levobupivacaine (T2). If correction of blood pressure was indicated, a third measurement was performed (T3). The following microcirculatory parameters were calculated: microvascular flow index, proportion of perfused vessels, perfused vessel density and total vessel density. Data are presented as median [IQR].

Results

Mean arterial pressure decreased from 73 mmHg (68–83) at T1 to 63 mmHg (±11) at T2 (p = 0.001) with a systolic blood pressure of 114 mmHg (98–128) and 87 (81–97), respectively (p = 0.001). The microcirculatory parameters of the bowel serosa, however, were unaltered. In seven patients, blood pressure was corrected to baseline values from a MAP of 56 mmHg (55–57), while microcirculatory parameters remained constant.

Conclusion

We examined the effects of TEA on the intestinal serosal microcirculation during abdominal surgery using IDF imaging for the first time in patients. Regardless of a marked decrease in hemodynamics, microcirculatory parameters of the bowel serosa were not significantly affected.

Trial registry number

ClinicalTrials.gov identifier NCT02688946.

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Title: Effects of Thoracic Epidural Anaesthesia on the Serosal Microcirculation of the Human Small Intestine
Authors: A. L. M. Tavy
A. F. J. de Bruin
K. van der Sloot
E. C. Boerma
C. Ince
P. G. Noordzij
D. Boerma
M. van Iterson
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 12/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4746-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Effects of Thoracic Epidural Anaesthesia on the Serosal Microcirculation of the Human Small Intestine

Abstract

Background

Methods

Results

Conclusion

Trial registry number

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registry number

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