open access

Vol 48, No 2 (2016)
Original and clinical articles
Published online: 2016-03-07
Submitted: 2015-11-24
Accepted: 2016-02-28
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The influence of epidural blockade on gut permeability in patients undergoing open surgical repair of abdominal aortic aneurysm

Radosław Owczuk, Anna Dylczyk-Sommer, Jacek Wojciechowski, Monika Paszkiewicz, Maria Wujtewicz, Piotr Stepnowski, Paweł Twardowski, Wioletta Sawicka, Michał Domżalski, Magdalena A. Wujtewicz
DOI: 10.5603/AIT.a2016.0014
·
Anaesthesiol Intensive Ther 2016;48(2):122-127.

open access

Vol 48, No 2 (2016)
Original and clinical articles
Published online: 2016-03-07
Submitted: 2015-11-24
Accepted: 2016-02-28

Abstract

BACKGROUND: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes.

METHODS: Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio.

RESULTS: No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G.

CONCLUSIONS: Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.

Abstract

BACKGROUND: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes.

METHODS: Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio.

RESULTS: No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G.

CONCLUSIONS: Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.

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Keywords

aortic aneurysm, repair, open surgery; gut, barrier, assessment; anaesthesia, regional, epidural blockade

About this article
Title

The influence of epidural blockade on gut permeability in patients undergoing open surgical repair of abdominal aortic aneurysm

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 48, No 2 (2016)

Pages

122-127

Published online

2016-03-07

DOI

10.5603/AIT.a2016.0014

Bibliographic record

Anaesthesiol Intensive Ther 2016;48(2):122-127.

Keywords

aortic aneurysm
repair
open surgery
gut
barrier
assessment
anaesthesia
regional
epidural blockade

Authors

Radosław Owczuk
Anna Dylczyk-Sommer
Jacek Wojciechowski
Monika Paszkiewicz
Maria Wujtewicz
Piotr Stepnowski
Paweł Twardowski
Wioletta Sawicka
Michał Domżalski
Magdalena A. Wujtewicz

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