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Effects of epidural anaesthesia on microcirculatory blood flow in free flaps in patients under general anaesthesia

Published online by Cambridge University Press:  16 August 2006

D. Erni ,
A. Banic ,
C. Signer  and
G. H. Sigurdsson
D. Erni
Affiliation:
Department of Plastic and Reconstructive Surgery, University Hospital Inselspital, Berne, Switzerland
A. Banic
Affiliation:
Department of Plastic and Reconstructive Surgery, University Hospital Inselspital, Berne, Switzerland
C. Signer
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, University Hospital Inselspital, Berne, Switzerland
G. H. Sigurdsson
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, University Hospital Inselspital, Berne, Switzerland
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Abstract

It has been suggested that epidural anaesthesia may increase blood flow in free flaps on the lower extremity. The objective of the present study was to test this hypothesis in 21 patients undergoing reconstructive surgery of the lower extremity with free muscle (n=8), fasciocutaneous (n=6) or musculocutaneous (n=7) flaps. Microcirculatory blood flow was measured continuously with a multichannel laser Doppler flowmetry, both in muscle and skin of the free flap as well as in the intact skin and muscle on the same extremity. After completion of surgery, general anaesthesia was continued and the epidural block was induced by an injection of 2% lignocaine-hydrochloride into a pre-operatively inserted and tested epidural catheter. The epidural block caused no change in microcirculatory flow in the intact skin and muscle, however, it resulted in a marked decrease in microcirculatory blood flow in all the free flaps studied (20–30%; P < 0.05). The epidural block also caused a significant decrease in mean arterial blood pressure, from 85 (±2.8) mmHg to 68 (±2.8) mmHg (P < 0.01). It was concluded that epidural anaesthesia may decrease microcirculatory blood flow in free flaps on the lower extremity by diverting flow away from the flap to normal intact tissues (a steal phenomenon).

Keywords

epidural anaesthesialaser Doppler flowmetrymicrocirculationmicrovascular surgeryskeletal musclemusculocutaneousfasciocutaneousfree flaps
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 16 , Issue 10 , October 1999 , pp. 692 - 698
Copyright
1999 European Society of Anaesthesiology

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