Hypotension associated with mts is aggravated by early activation of tea during open esophagectomy
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Hypotension associated with mts is aggravated by early activation of tea during open esophagectomy. / Strandby, Rune B.; Ambrus, Rikard; Ring, Linea L.; Nerup, Nikolaj; Secher, Niels H.; Goetze, Jens P.; Achiam, Michael P.; Svendsen, Lars B.
I: Local and Regional Anesthesia, Bind 14, 2021, s. 33-42.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hypotension associated with mts is aggravated by early activation of tea during open esophagectomy
AU - Strandby, Rune B.
AU - Ambrus, Rikard
AU - Ring, Linea L.
AU - Nerup, Nikolaj
AU - Secher, Niels H.
AU - Goetze, Jens P.
AU - Achiam, Michael P.
AU - Svendsen, Lars B.
PY - 2021
Y1 - 2021
N2 - Objective: A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI2)induced vasodilation and identified by facial flushing, tachycardia, and hypotension during abdominal surgery. We evaluated whether thoracic epidural anesthesia (TEA) influences the incidence of MTS. Design: Randomized, blinded controlled trial. Setting: Single-center university hospital. Participants: Fifty patients undergoing open esophagectomy. Interventions: Patients were randomized to either early (EA, after induction of general anesthesia) or late activation of TEA (LA, after re-established gastric continuity). Plasma 6-keto-PGF1α, a stable metabolite of PGI2 and interleukine-6 (IL6) were measured in plasma during surgery along with hemodynamic variables and MTS graded according to facial flushing together with plasma C-reactive protein on the third post-operative day. Results: Forty-five patients met the inclusion criteria. Development of MTS tended to be more prevalent with EA (n=13/25 [52%]) than with LA TEA (n=5/20 [25%], p=0.08). For patients who developed MTS, there was a transient increase in plasma 6-keto-PGF1α by 15 min of surgery and plasma IL6 (p<0.001) as C-reactive protein (P<0.009) increased. EA TEA influenced the amount of phenylephrine needed to maintain mean arterial pressure >60 mmHg in patients who developed MTS (0.16 [0.016–0.019] mg/min vs MTS and LA TEA 0.000 [0.000–0.005] mg/min, p<0.001). Conclusion: The incidence of MTS is not prevented by TEA in patients undergoing open esophagectomy. On the contrary, the risk of hypotension is increased in patients exposed to TEA during surgery, and the results suggest that it is advantageous to delay activation of TEA. Also, MTS seems to be associated with a systemic inflammatory response, maybe explaining the aggravated post-operative outcome.
AB - Objective: A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI2)induced vasodilation and identified by facial flushing, tachycardia, and hypotension during abdominal surgery. We evaluated whether thoracic epidural anesthesia (TEA) influences the incidence of MTS. Design: Randomized, blinded controlled trial. Setting: Single-center university hospital. Participants: Fifty patients undergoing open esophagectomy. Interventions: Patients were randomized to either early (EA, after induction of general anesthesia) or late activation of TEA (LA, after re-established gastric continuity). Plasma 6-keto-PGF1α, a stable metabolite of PGI2 and interleukine-6 (IL6) were measured in plasma during surgery along with hemodynamic variables and MTS graded according to facial flushing together with plasma C-reactive protein on the third post-operative day. Results: Forty-five patients met the inclusion criteria. Development of MTS tended to be more prevalent with EA (n=13/25 [52%]) than with LA TEA (n=5/20 [25%], p=0.08). For patients who developed MTS, there was a transient increase in plasma 6-keto-PGF1α by 15 min of surgery and plasma IL6 (p<0.001) as C-reactive protein (P<0.009) increased. EA TEA influenced the amount of phenylephrine needed to maintain mean arterial pressure >60 mmHg in patients who developed MTS (0.16 [0.016–0.019] mg/min vs MTS and LA TEA 0.000 [0.000–0.005] mg/min, p<0.001). Conclusion: The incidence of MTS is not prevented by TEA in patients undergoing open esophagectomy. On the contrary, the risk of hypotension is increased in patients exposed to TEA during surgery, and the results suggest that it is advantageous to delay activation of TEA. Also, MTS seems to be associated with a systemic inflammatory response, maybe explaining the aggravated post-operative outcome.
KW - Epidural anesthesia
KW - Esophagectomy
KW - Mesenteric traction syndrome
U2 - 10.2147/LRA.S294556
DO - 10.2147/LRA.S294556
M3 - Journal article
C2 - 33688249
AN - SCOPUS:85102466481
VL - 14
SP - 33
EP - 42
JO - Local and Regional Anesthesia
JF - Local and Regional Anesthesia
SN - 1178-7112
ER -
ID: 259051791