Thoracic epidural anesthesia attenuates hemorrhage-induced impairment of intestinal perfusion in rats

被引:47
作者
Adolphs, J [1 ]
Schmidt, DK [1 ]
Mousa, SA [1 ]
Kamin, B [1 ]
Korsukewitz, I [1 ]
Habazettl, H [1 ]
Schäfer, M [1 ]
Welte, M [1 ]
机构
[1] Free Univ Berlin, Dept Anesthesia & Intens Care Med, D-12200 Berlin, Germany
关键词
D O I
10.1097/00000542-200309000-00025
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: During hemorrhagic hypotension, sympathetic vasoconstriction crucially contributes to gut mucosal damage. Sympathetic blockade by thoracic epidural anesthesia has been shown to increase mucosal microvascular perfusion and to improve survival after severe hemorrhage in laboratory animals. This study investigates the effects of thoracic epidural anesthesia on intestinal microvascular perfusion during hemorrhagic hypotension in rats. Methods: In 32 anesthetized Sprague-Dawley rats either lidocaine 2% (thoracic epidural anesthesia) or normal saline (control) was infused via thoracic epidural catheters. Hemorrhagic hypotension (mean arterial pressure 30 mmHg for 60 min) was induced by withdrawal of blood, which was subsequently retransfused for resuscitation. Functional capillary density and erythrocyte velocity in the mucosa and muscularis were determined by intravital microscopy. Leukocyte-endothelium interaction was studied in postcapillary venules and sympathetic nerve fibers of the intestinal wall were identified by immunohistochemistry. Results: During hypotension functional capillary density was significantly (P < 0.001) lower in the muscularis of the control group (median [25/75 percentile]: -46.5% [-59.6/-20.8%] change from baseline) as compared with animals that received thoracic epidural anesthesia (-6.1% [-13.4/1.1%]). There were no differences in erythrocyte velocity between groups throughout the experiment. Leukocyte rolling increased significantly (P < 0.001) after resuscitation in control (12 [6/15] vs. baseline 2.5 [1/8]) but not in thoracic epidural anesthesia (4 [2.3/7] vs. baseline: 5 [3/15.5]). Sympathetic nerve fibers were identified in the muscularis and submucosa but not in the mucosa. Conclusions: During hemorrhagic hypotension and after resuscitation, thoracic epidural anesthesia has beneficial effects on intestinal microvascular perfusion. Because of blockade of sympathetic nerves, thoracic epidural anesthesia prevents perfusion impairment of the muscularis during hypotension and attenuates leukocyte rolling after resuscitation.
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页码:685 / 692
页数:8
相关论文
共 41 条
[21]   Co-expression of β-endorphin with adhesion molecules in a model of inflammatory pain [J].
Mousa, SA ;
Machelska, H ;
Schäfer, M ;
Stein, C .
JOURNAL OF NEUROIMMUNOLOGY, 2000, 108 (1-2) :160-170
[22]   Intravenous lidocaine attenuates acute lung injury induced by hydrochloric acid aspiration in rabbits [J].
Nishina, K ;
Mikawa, K ;
Takao, Y ;
Shiga, M ;
Maekawa, N ;
Obara, H .
ANESTHESIOLOGY, 1998, 88 (05) :1300-1309
[23]   Functional capillary density: An indicator of tissue perfusion? [J].
Nolte, D ;
Zeintl, H ;
Steinbauer, M ;
Pickelmann, S ;
Messmer, K .
INTERNATIONAL JOURNAL OF MICROCIRCULATION-CLINICAL AND EXPERIMENTAL, 1995, 15 (05) :244-249
[24]  
Otton P E, 1966, Can Anaesth Soc J, V13, P541, DOI 10.1007/BF03002223
[25]  
PECK SL, 1985, J PHARMACOL EXP THER, V235, P418
[26]   HEMODYNAMIC AND METABOLIC EFFECTS OF HEMORRHAGE IN MAN WITH PARTICULAR REFERENCE TO SPLANCHNIC CIRCULATION [J].
PRICE, HL ;
DEUTSCH, S ;
MARSHALL, BE ;
STEPHEN, GW ;
BEHAR, MG ;
NEUFELD, GR .
CIRCULATION RESEARCH, 1966, 18 (05) :469-&
[27]   EFFECTS OF HEMORRHAGE ON INTRAMURAL BLOOD-FLOW DISTRIBUTION, VILLOUS TISSUE OSMOLALITY AND FLUID ELECTROLYTE TRANSPORT IN THE CAT SMALL-INTESTINE [J].
REDFORS, S ;
HALLBACK, DA ;
SJOVALL, H ;
JODAL, M ;
LUNDGREN, O .
ACTA PHYSIOLOGICA SCANDINAVICA, 1984, 121 (03) :211-222
[28]   MESENTERIC MICROCIRCULATORY CHANGES IN NONLETHAL HEMORRHAGIC-SHOCK - THE ROLE OF RESUSCITATION WITH BALANCED ELECTROLYTE OR HYPERTONIC SALINE DEXTRAN [J].
SCALIA, SV ;
TAHERI, PA ;
FORCE, S ;
OZMEN, V ;
LUI, D ;
FISH, J ;
HANSEN, D ;
CHAMBERS, R ;
FLINT, L ;
STEINBERG, S ;
HASSETT, JM ;
FARRELL, K ;
FLYNN, W ;
SHACKFORD, S ;
SCALIA, SV .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1992, 33 (02) :321-325
[29]   SPREAD OF EXTRADURAL ANALGESIA FOLLOWING CAUDAL INJECTION IN CHILDREN - STATISTICAL STUDY [J].
SCHULTESTEINBERG, O ;
RAHLFS, VW .
BRITISH JOURNAL OF ANAESTHESIA, 1977, 49 (10) :1027-1034
[30]   INTRAMURAL DISTRIBUTION OF INTESTINAL BLOOD-FLOW DURING SYMPATHETIC-STIMULATION [J].
SHEPHERD, AP ;
RIEDEL, GL .
AMERICAN JOURNAL OF PHYSIOLOGY, 1988, 255 (05) :H1091-H1095