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      The effect of epidural anesthesia on muscle flap tolerance to venous ischemia

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      Author
      Cayci, C.
      Cinar, C.
      Yucel, O. A.
      Tekinay, T.
      Ascherman, J. A.
      Date
      2010
      Source Title
      Plastic and Reconstructive Surgery
      Print ISSN
      0032-1052
      Publisher
      Lippincott Williams & Wilkins
      Volume
      125
      Issue
      1
      Pages
      89 - 98
      Language
      English
      Type
      Article
      Item Usage Stats
      116
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      108
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      Abstract
      Background: Venous ischemia is a major cause of failure after free tissue transfers and replantations. The combination of general and epidural anesthesia leads to vasodilatation and improves tissue perfusion. Postoperative pain relief and sympathetic blockage are additional benefits of epidural anesthesia. The purpose of this study was to determine whether epidural anesthesia has benefits on microcirculation and neutrophil functions in muscle flaps subjected to venous ischemia. Method: Thirty Sprague-Dawley rats were divided into three groups: group I, general anesthesia; group II, spinal anesthesia; and group III, epidural anesthesia. Cremaster flaps were prepared, postcapillary venules were selected under intravital videomicroscopy, and flaps were subjected to venous ischemia. Images were recorded from preselected postcapillary venules before venous ischemia (baseline) and following reperfusion. Neutrophil rolling and adhesion, functional capillary density, and diameters of postcapillary venules were evaluated. Results: The increase in rolling neutrophils in group III was significantly lower than in groups I and II at 60 and 120 minutes. Change of adherent neutrophils in group III was significantly lower than in groups I and II at 15, 60 and 120 minutes. There was significantly more reduction in inner diameter of postcapillary venules in groups I and II compared with group III. Functional capillary density in groups I and II was significantly lower than in group III. Conclusion: Epidural anesthesia regulated neutrophil functions, salvaged functional capillaries, and prevented vasoconstriction of postcapillary venules in cremaster muscle flaps subjected to venous ischemia. Spinal and general anesthesia, however, were found to be ineffective in improving microcirculation of muscle flaps subjected to venous ischemia.
      Keywords
      Animal
      Capillary
      Epidural anesthesia
      Ischemia
      Microcirculation
      Neutrophil
      Pathophysiology
      Physiology
      Plastic surgery
      Rat
      Vascularization
      Neutrophils
      Surgical flaps
      Permalink
      http://hdl.handle.net/11693/22475
      Published Version (Please cite this version)
      https://doi.org/10.1097/PRS.0b013e3181c49544
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      • Institute of Materials Science and Nanotechnology (UNAM) 1858
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