Avtor/Urednik		Požar-Lukanović, Neva; Stanisavljevič, Dragoje; Sojar, Valentin; Paver-Eržen, Vesna
Naslov		Influence of thoracic epidural anasthesia on intestinal blood supply
Prevedeni naslov		Vpliv torakalne epiduralne anestezije na prekrvitev prebavil
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 75, št. 1
Leto izdaje		2006
Obseg		str. 9-15
Jezik		eng
Abstrakt		Background To date research has demonstrated that the use of general anaesthesia in combination with thoracic epidural anaesthesia (TEA) protects the patient against surgical stress. There is disagreement, however, concerning the effect of TEA on intestinal blood supply. In order to determine the influence of TEA on intestinal blood flow, partial O2, pressure (pO2) and pH were determined in the portal blood that drains blood from intestine, just before liver resection. These values were compared with those measured in the superior caval vein which drains blood from the upper part of the body, region not directly affected by TEA. Methods Forty patients included in our prospective randomized study were divided into twogroups, i.e. a group of 20 patients given TEA in combination with general anaesthesia, and a group of 20 patients receiving only general anaesthesia. They were premedicated with midazolam 1.5-3.0 mg i.v. Immediately after introduction of an epidural catheter at T11-T12, 15 ml of 0.25% local anaesthetic bupivacain or 15 ml of 0.9% NaCl was injected into the thoracic epidural space in the TEA group and in the control group, respectively. Anaesthesia was initiated by intravenous opioid analgesic fentanyl 0.1-0.2 mg, thiopentone 4.0 mg/kg body weight, and muscle relaxant vecuronium 0.1 mg/kg body weight. The patients were intubated and controlled ventilation was started with a 45 to 55 per cent oxygen-air mixture with addition of the volatile agent isoflurane 0.8-1.5%. Muscle relaxation was maintained with vecuronium at a dose of 2-4 mg i.v. Central venous pressure was maintained at a low normal limit, i. e. 6+-2 mmHg. Just before liver resection, blood samples were obtained from the portal vein and superior caval vein. Intestinal blood supply was evaluated by measuring pO2 and pH in the portal vein, and the results were compared with the values obtained in the superior caval vein in each patient and in the two groups. (Abstract truncated at 2000 characters)
Izvleček		Izhodišča. Številni raziskovalci so ugotavljali povezanost hipoksije črevesne sluznice med različnimi kirurškimi posegi z nastankom pooperacijskih zapletov. Zaradi anatomskih in fizioloških posebnosti je črevesna sluznica zelo občutljiva za hipoksijo, ki je z običajnimi meritvami, ki jih nadzorujemo med operacijo (krvni tlak, frekvenca srčnega utripa, urno iločanje seča), ne moremo zaznati. Vsako povečanje presnovne potrebe za kisik ali pa zmanjšana sposobnost za prenos kisika lahko vodi v hipoksijo in posledično acidozo črevesne sluznice. Predhodne raziskave so pokazale, da kombinacija splošne in torakalne epiduralne anestezije (TEA) zaščiti bolnika pred vplivi operacijskega srtresa. O učinku TEA na prekrvitev črevesa pa so mnenja deljena. Da bi ugotovili vpliv TEA na prekrvitev črevesa, smo pri bolnikih tik pred začetkom jetrne resekcije v portalni krvi, kamor se izteka kri iz prebavil, določali delni tlak O2 (pO2) in pH. Te vrednosti smo primerjali z enakimi v krvi zgornje vene kave, kamor se izteka kri iz zgornjega dela telesa, kjer vpliv TEA ni bil neposredno izražen. Metode. V prospektivni, randomizirani raziskavi smo 40 bolnikov razdelili v dve skupini. V TEA skupini je 20 bolnikov dobilo TEA in splošno anestezijo in 20 bolnikov v kontrolni skupini samo splošno anestezijo. Za premedikacijo so bolniki dobili midazolam v odmerku 1,5 -3,0 mg vensko. Vstavili smo jim epiduralni kateter v višini med 11. in 12. torakalnim vretencem takoj po vstavitvi katetra smo bolnikom v TEA skupini vbrizgali v epiduralni prostor 15 ml 0,25% lokalnega anestetika bupivakaina, kontrolni skupini pa 15 ml 0,9% NaCl. Za uvod v anastezijo smo vsem bolnikom dali vensko 0,1-0,2 mg opioidnega analgetika fentanila, 4,0 mg/kg TT uspavala tiopentala in 0,1 mg/kg TT mišičnega relaksanta vekuronija, jih intubirali in nadzorovano predihavali z mešanico kisika in zraka v razmerju 45%:55% ob dodatku hlapnega anestetika izoflurana v koncentraciji 0,8-1,5 vol.%. (Izvleček prekinjen pri 2000 znakih)
Deskriptorji		ANESTHESIA, EPIDURAL ANESTHESIA, GENERAL LIVER DISEASES BILIARY TRACT SURGERY CATHETERIZATION, CENTRAL VENOUS PORTAL VEIN VENA CAVA, SUPERIOR BLOOD GAS ANALYSIS OXYGEN HYDROGEN-ION CONCENTRATION