Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group [Group A, n=16] and the control group [Group B, n=14]. After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO[2] levels and the calculation of regional-arterial Co[2] difference [deltaP CO[2]]. Additional measurements included mean arterial pressure [MAP], cardiac output [CO], systemic vascular resistance [SVR], and arterial lactate levels. There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO[2] increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results

Pregnancy at term does not alter the responses to a mechanical and an electrical stimulus after skin emla application

Pregnancy is associated with reduced local anesthetic requirements and increased pain thresholds, possibly due to hormonal changes and activation of endogenous opioids. We compared the responses to a mechanical and an electrical stimulus in 30 pregnant women [pregnant group] scheduled for cesarean section and 30 healthy female volunteers [control group] matched for age. Pain was assessed by Visual Analogue Scale [VAS] on two different days after skin application of EMLA or placebo cream on the forearms. EMLA and placebo cream were randomly applied on the medial surface of both forearms for 30 min in a blind cross over manner and the subjects received a mechanical stimulus generated through a pressor palpator followed by an electrical stimulus generated through a nerve stimulator. Average VAS values from both trials did not differ between pregnant and control group exposed to the mechanical or electrical stimulus after EMLA application or after mechanical or electrical stimulus after placebo cream application.. Late pregnancy is not associated with increased sensitivity to local anesthetics [EMLA] applied to the skin, under our study conditions