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The influence of thoracic epidural analgesia on transcapillary fluid balance in subcutaneous tissue
Author(s) -
REIN K.–A.,
STENSETH R.,
MYHRE H. O.,
LEVANG O. W.,
KROGSTAD A.
Publication year - 1989
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1989.tb02865.x
Subject(s) - oncotic pressure , medicine , anesthesia , interstitial fluid , extracorporeal circulation , catheter , surgery , albumin
Clinical observation and calculation of fluid balance have shown that patients undergoing aortocoronary bypass surgery with thoracic epidural analgesia (TEA) in addition to general anesthesia retain less fluid than patients having general anesthesia only. The present study was designed to investigate whether this effect could be explained by thoracic epidural analgesia influencing the transcapillary fluid balance, i.e. the transcapillary forces (COP pl , COP if , P if ). Interstitial fluid colloid osmotic pressure (COP if ) and interstitial fluid pressure (P if ) were measured subcutaneously at heart level by the blister suction technique and the wick–in–needle technique, respectively. Simultaneously plasma colloid osmotic pressure (COP pl ) was recorded. Sixteen male patients were allocated to two groups, one having general anesthesia only (controls, n = 8). The other group (TEA, n = 8) received, at the induction of anesthesia, bupivacaine 50 mg via an epidural catheter as an adjunct to general anesthesia. TEA was maintained by continuous infusion for 24 h postoperatively. Preoperatively no intergroup differences were observed in “the Starling forces” (COP pl , COP if , Pa if ). At the start of extracorporeal circulation COP pl was significantly lower in the TEA–group than in controls. During extracorporeal circulation the transcapillary COP–gradient (COP pl –COP if ) was reversed in both groups. At the end of extracorporeal circulation P if increased to a minor degree in the TEA–group and remained significantly lower than in controls from 3 to 24 h postoperatively. The subcutaneous interstitial tissue could be less expanded postoperatively in the TEA–group, also reflected by a lower increase in P if .