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Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy
OBJECTIVE: A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI(2))-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: Randomi...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936689/ https://www.ncbi.nlm.nih.gov/pubmed/33688249 http://dx.doi.org/10.2147/LRA.S294556 |
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author | Strandby, Rune B Ambrus, Rikard Ring, Linea L Nerup, Nikolaj Secher, Niels H Goetze, Jens P Achiam, Michael P Svendsen, Lars B |
author_facet | Strandby, Rune B Ambrus, Rikard Ring, Linea L Nerup, Nikolaj Secher, Niels H Goetze, Jens P Achiam, Michael P Svendsen, Lars B |
author_sort | Strandby, Rune B |
collection | PubMed |
description | OBJECTIVE: A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI(2))-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-PGF(1α), a stable metabolite of PGI(2) 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-PGF(1α) 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. |
format | Online Article Text |
id | pubmed-7936689 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-79366892021-03-08 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 Local Reg Anesth Original Research OBJECTIVE: A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI(2))-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-PGF(1α), a stable metabolite of PGI(2) 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-PGF(1α) 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. Dove 2021-03-02 /pmc/articles/PMC7936689/ /pubmed/33688249 http://dx.doi.org/10.2147/LRA.S294556 Text en © 2021 Strandby et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Strandby, Rune B Ambrus, Rikard Ring, Linea L Nerup, Nikolaj Secher, Niels H Goetze, Jens P Achiam, Michael P Svendsen, Lars B Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy |
title | Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy |
title_full | Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy |
title_fullStr | Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy |
title_full_unstemmed | Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy |
title_short | Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy |
title_sort | hypotension associated with mts is aggravated by early activation of tea during open esophagectomy |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936689/ https://www.ncbi.nlm.nih.gov/pubmed/33688249 http://dx.doi.org/10.2147/LRA.S294556 |
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