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

Date
2010
Authors
Cayci, C.
Cinar, C.
Yucel, O. A.
Tekinay, T.
Ascherman, J. A.
Advisor
Supervisor
Co-Advisor
Co-Supervisor
Instructor
Source Title
Plastic and Reconstructive Surgery
Print ISSN
0032-1052
Electronic ISSN
Publisher
Lippincott Williams & Wilkins
Volume
125
Issue
1
Pages
89 - 98
Language
English
Type
Article
Journal Title
Journal ISSN
Volume Title
Series
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.

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Book Title
Keywords
Animal, Capillary, Epidural anesthesia, Ischemia, Microcirculation, Neutrophil, Pathophysiology, Physiology, Plastic surgery, Rat, Vascularization, Neutrophils, Surgical flaps
Citation
Published Version (Please cite this version)