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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2015; 4(1): 89-104
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.89
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.89
Thoracic epidural anesthesia: Effects on splanchnic circulation and implications in Anesthesia and Intensive care
Antonio Siniscalchi, Lorenzo Gamberini, Cristiana Laici, Tommaso Bardi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
Author contributions: Siniscalchi A, Gamberini L, Laici C, Bardi T and Faenza S contributed to this manuscript.
Supported by The Department of Anesthesiology of the University of Bologna.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Siniscalchi, MD, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. sinianest@libero.it
Telephone: +39-05-16363440
Received: August 27, 2014
Peer-review started: August 31, 2014
First decision: October 14, 2014
Revised: October 21, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 4, 2015
Peer-review started: August 31, 2014
First decision: October 14, 2014
Revised: October 21, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 4, 2015
Core Tip
Core tip: Effects of thoracic epidural anesthesia on splanchnic circulation are still poorly understood. The influence on macro-hemodynamics seems to vary based on the metameric extension of the blockade, the volume repletion and the hemodynamic status of the patient. Thus epidural anesthesia could reduce regional blood flow to splanchnic organs and have detrimental effects on oxygen delivery. However, there is increasing evidence, in particular deriving from animal studies, of a possible protective effect on microcirculation of the epidural blockade, especially in low flow states. In fact, despite reducing perfusion pressure, thoracic epidural anesthesia could foster perfusion of microcirculatory weak units and reduce local dysoxia.