Hemodynamic effects of thoracic epidural analgesia in ovine hyperdynamic endotoxemia

Daudel, Fritz; Ertmer, Christian; Stubbe, Henning D; Lange, Matthias; Pulina, Rafael; Bone, Hans-Georg; Sielenkämper, Andreas W; Van Aken, Hugo; Westphal, Martin (2007). Hemodynamic effects of thoracic epidural analgesia in ovine hyperdynamic endotoxemia. Regional anesthesia and pain medicine, 32(4), pp. 311-6. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1016/j.rapm.2007.04.005

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BACKGROUND AND OBJECTIVES: Thoracic epidural analgesia (TEA) is increasingly used for perioperative analgesia. If patients with TEA develop sepsis or systemic inflammatory response subsequent to extended surgery the question arises if it would be safe to continue TEA with its beneficial effects of improving gastrointestinal perfusion and augmenting tissue oxygenation. A major concern in this regard is hemodynamic instability that might ensue from TEA-induced vasodilation. The objective of the present study was to assess the effects of TEA on systemic and pulmonary hemodynamics in a sepsis model of hyperdynamic endotoxemia. METHODS: After a baseline measurement in healthy sheep (n = 14), Salmonella thyphosa endotoxin was continuously infused at a rate of 10 ngxkg(-1)xmin(-1) over 16 hours. The surviving animals (n = 12) were then randomly assigned to 1 of 2 study groups. In the treatment group (n = 6), continuous TEA was initiated with 0.1 mLxkg(-1) bupivacaine 0.125% and maintained with 0.1 mLxkg(-1)xh(-1). In the control group (n = 6) the same amount of isotonic sodium saline solution was injected at the same rate through the epidural catheter. RESULTS: In both experimental groups cardiac index increased and systemic vascular resistance decreased concurrently (each P < .05). Functional epidural blockade in the TEA group was confirmed by sustained suppression of the cutaneous (or panniculus) reflex. During the observational period of 6 hours neither systemic nor pulmonary circulatory variables were impaired by TEA. CONCLUSIONS: From a hemodynamic point of view, TEA presents as a safe treatment option in sepsis or systemic inflammatory response syndrome.

Item Type:	Journal Article (Original Article)
ISSN:	1098-7339
ISBN:	17720115
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:55
Last Modified:	04 May 2014 23:16
Publisher DOI:	10.1016/j.rapm.2007.04.005
PubMed ID:	17720115
Web of Science ID:	000249513500007
URI:	https://boris.unibe.ch/id/eprint/23569 (FactScience: 42532)