The effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion on gastric tube blood flow during esophagectomy

Anesth Analg. 2008 Mar;106(3):884-7, table of contents. doi: 10.1213/ane.0b013e318164f153.

Abstract

Background: Gastric tube necrosis is a major cause of anastomotic leak after esophagectomy. A correlation has been shown between reduced flux at the anastomotic end of the gastric tube and anastomotic leaks.

Methods: We prospectively studied the effect of intraoperative thoracic epidural bupivacaine and subsequent adrenaline infusion on hemodynamics and flux in the gastric tube.

Results: Administering the epidural bolus significantly decreased flux at the anastomotic end of the gastric tube (P < 0.01). Gastric flux was returned to baseline by an adrenaline infusion.

Conclusions: The administration of a thoracic epidural bolus may decrease flux at the anastomotic end of the gastric tube.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Analgesia, Epidural / methods*
  • Anastomosis, Surgical / adverse effects
  • Anesthetics, Local / administration & dosage*
  • Blood Flow Velocity / drug effects
  • Blood Pressure / drug effects
  • Bupivacaine / administration & dosage*
  • Cardiac Output / drug effects
  • Epinephrine / administration & dosage*
  • Esophagectomy / adverse effects*
  • Female
  • Humans
  • Infusions, Intravenous
  • Injections, Epidural
  • Intraoperative Care
  • Ischemia / etiology
  • Ischemia / physiopathology
  • Ischemia / prevention & control
  • Laser-Doppler Flowmetry
  • Male
  • Prospective Studies
  • Regional Blood Flow / drug effects
  • Stomach / blood supply*
  • Stomach / surgery
  • Surgically-Created Structures / blood supply*
  • Thoracic Vertebrae
  • Vasoconstrictor Agents / administration & dosage*

Substances

  • Anesthetics, Local
  • Vasoconstrictor Agents
  • Bupivacaine
  • Epinephrine