• Carolien S E Bulte, Christa Boer, Koen J Hartemink, Otto Kamp, Martijn W Heymans, Stephen A Loer, Stefano F de Marchi, Rolf Vogel, and R Arthur Bouwman.
• Department of Anesthesiology, VU University Medical Center, MB Amsterdam, The Netherlands. Electronic address: c.bulte@vumc.nl.
• J. Cardiothorac. Vasc. Anesth. 2017 Feb 1; 31 (1): 134-141.

ObjectiveTo evaluate the effect of acute cardiac sympathectomy by thoracic epidural anesthesia on myocardial blood flow and microvascular function.DesignA prospective observational study.SettingThe study was conducted in a tertiary teaching hospital.ParticipantsTen patients with a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery.InterventionsMyocardial contrast echocardiography was used to study myocardial blood flow and microvascular responsiveness at rest, during adenosine-induced hyperemia, and after sympathetic stimulation by the cold pressor test. Repeated measurements were performed without and with thoracic epidural anesthesia.Measurements And Main ResultsAn increased myocardial blood volume was observed with thoracic epidural anesthesia compared to baseline (from 0.08±0.02 to 0.10±0.03 mL/mL; p = 0.02). No difference existed in resting myocardial blood flow between baseline conditions and epidural anesthesia (0.85±0.24 v 1.03±0.27 mL/min/g, respectively). Hyperemia during thoracic epidural anesthesia increased myocardial blood flow to 4.31±1.07 mL/min/g (p = 0.0008 v baseline) and blood volume to 0.17±0.04 mL/mL (p = 0.005 baseline). After sympathetic stimulation, no difference in myocardial blood flow parameters was observed CONCLUSIONS: Acute cardiac sympathectomy by thoracic epidural anesthesia increased the blood volume in the myocardial capillary system. Also, thoracic epidural anesthesia increased hyperemic myocardial blood flow, indicating augmented endothelial-independent vasodilator capacity of the myocardium.Copyright © 2017. Published by Elsevier Inc.

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