Skip to main content

Epidural analgesia, gastrointestinal motitity and intestinal blood flow


--Thoracic (above the T12 dermatome) epidural local anesthetics (e.g. bupivacaine) can have clinically significant effects to decrease the duration of ileus after abdominal surgery.

--The most optimal post-op analgesia , in terms of minimizing post-op ileus, appears to be a combination of low-dose epidural bupivacaine plus morphine.

--In order for this combination to be effective, it should be delivered via a thoracic epidural catheter, ideally with the tip of the catheter as close as possible to the dermatome in the middle of the surgical incision. (e.g. T10 for an upper abdominal incision)


Safeguarding intestinal perfusion is a critical issue in the maintenance of intestinal function and integrity of the mucosal barrier.
The effect of epidural bupivacaine (5mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in patients during large bowel resection.
In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41%.
(K. Johansson British Journal of Surgery 2005 Vol 75 Issue 1, P 73-76)


Epidural analgesia increased 7-day surival from 33% to 73% (p<0.05)
Thoracic epidural analgesia attenuated systemic response and improved survival in severe acute pancreatitis.
These effects might be explained by improved mucosal perfusion.
(Freise Hendrik Anesthesiology 2006; 105(2):354-9.)


After oesophagectomy, continuous infusion bupivacaine 10 ml/hr, increased the anastomotic mucosal blood flow.
(Michelet P et. al acta anesthesiol. Scan. 2007 51:587-94)


Thoracic epidural analgesia provides a significant benefit in terms of
*less analgesic consumption
*better post-op pain relief
*and faster recovery of gastrointestinal function
in patients undergoing laparoscopic colorectal resection
(ZINGG Urs 2009, vol 23, n2 pp. 276-282)
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...
1 comment
Read more