Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy

A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI )-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. Randomized, blinded controlled trial. Single-center university hospital. Fifty patients undergoing open esophagectomy. 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 , a stable metabolite of PGI 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. 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 by 15 min of surgery and plasma IL6 (p