Thoracic epidural anesthesia reverses sepsis-induced hepatic hyperperfusion and reduces leukocyte adhesion in septic ratsReportar como inadecuado




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Critical Care

, 13:R116

First Online: 13 July 2009Received: 26 March 2009Accepted: 13 July 2009

Abstract

IntroductionLiver dysfunction is a common feature of severe sepsis and is associated with a poor outcome. Both liver perfusion and hepatic inflammatory response in sepsis might be affected by sympathetic nerve activity. However, the effects of thoracic epidural anesthesia TEA, which is associated with regional sympathetic block, on septic liver injury are unknown. Therefore, we investigated hepatic microcirculation and inflammatory response during TEA in septic rats.

MethodsForty-five male Sprague-Dawley-rats were instrumented with thoracic epidural catheters and randomized to receive a sham procedure Sham, cecal ligation and puncture CLP without epidural anesthesia Sepsis and CLP with epidural infusion of 15 ul-h bupivacaine 0.5% Sepsis + TEA. All animals received 2 ml-100 g-h NaCl 0.9%. In 24 n = 8 in each group rats, sinusoidal diameter, loss of sinusoidal perfusion and sinusoidal blood flow as well as temporary and permanent leukocyte adhesion to sinusoidal and venolar endothelium were recorded by intravital microscopy after 24 hours. In 21 n = 7 in each group separate rats, cardiac output was measured by thermodilution. Blood pressure, heart rate, serum transaminase activity, serum TNF-alpha concentration and histologic signs of tissue injury were recorded.

ResultsWhereas cardiac output remained constant in all groups, sinusoidal blood flow increased in the Sepsis group and was normalized in rats subjected to sepsis and TEA. Sepsis-induced sinusoidal vasoconstriction was not ameliorated by TEA. In the Sepsis + TEA group, the increase in temporary venolar leukocyte adherence was blunted. In contrast to this, sinusoidal leukocyte adherence was not ameliorated in the Sepsis + TEA group. Sepsis-related release of TNF-alpha and liver tissue injury were not affected by Sepsis + TEA.

ConclusionsThis study demonstrates that TEA reverses sepsis-induced alterations in hepatic perfusion and ameliorates hepatic leukocyte recruitment in sepsis.

AbbreviationsANOVAanalysis of variance

CLPcecal ligation and puncture

ELISAenzyme-linked immunosorbent assay

HandEhematoxylin and eosin

HABRhepatic arterial buffer respsonse

NaClsodium chloride

TEAthoracic epidural anesthesia

TNFtumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-cc7965 contains supplementary material, which is available to authorized users.

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