Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery

Autor: Anastase Spiliopoulos, Marc Licker, Jean-Marie Tschopp
Rok vydání: 2003
Předmět:
Thorax
Male
Lung Neoplasms/physiopathology/surgery
Lung Neoplasms
Sympathetic Nervous System
Time Factors
Hypertension/etiology
Blood Pressure
Fentanyl
Postoperative Complications
Heart Rate
Tachycardia
Heart rate variability
Medicine
Blood Pressure/physiology
Lung
ddc:617
food and beverages
Tachycardia/etiology
Middle Aged
Analgesia
Epidural
Cardiothoracic surgery
Anesthesia
Analgesia
Patient-Controlled/methods
Hypertension
Postoperative Complications/etiology
Hypotension
Heart Rate/physiology
medicine.drug
Adult
medicine.medical_specialty
Baroreflex/physiology
Baroreflex
Anesthesia
General
Sympathetic Nervous System/physiopathology
Heart rate
Humans
Hypotension/etiology
Lung/surgery
Aged
Bupivacaine
business.industry
Analgesia
Epidural/methods
Anesthesia
General/methods
Analgesia
Patient-Controlled
Thoracic Surgical Procedures
Anesthesiology and Pain Medicine
Blood pressure
business
Zdroj: British Journal of Anaesthesia, Vol. 91, No 4 (2003) pp. 525-31
ISSN: 0007-0912
Popis: Background. Thoracic epidural analgesia (TEA) is effective in alleviating pain after major thoracoabdominal surgery and may also reduce postoperative mortality and morbidity. This study investigated cardiovascular autonomic control in patients undergoing elective thoracic surgery and its modulation by continuous TEA. Methods. Thirty-eight patients were randomly assigned to receive patient-controlled analgesia (PCA group) or thoracic epidural analgesia (TEA group) with doses of bupivacaine (0.25% during operation, 0.125% after operation) and fentanyl (2 m gm l ‐1 ). Heart rate variability (HRV), baroreflex function and pressure response to nitroglycerine and phenylephrine were assessed before operation, 4 h after the end of surgery (POD 0) and on the first and second postoperative days (POD 1 and POD 2). Results. Early after surgery, all HRV variables and baroreflex sensitivities were markedly decreased in both groups. In the TEA group, total HRV and its high-frequency components (HF) increased towards preoperative values at POD 1 and POD 2, whereas the ratio of low to high frequencies (LF/HF) was significantly reduced (mean (SD), ‐44 (15)% at POD 0, ‐38 (17)% at POD 1, ‐37 (18%) at POD 2) and associated with blunting of the postoperative increase in heart rate and blood pressure. In the PCA group, the ratio of LF/HF remained unchanged and the decrements in HRV variables persisted until POD 2. In the two groups, baroreflex sensitivities and pressure responses recovered preoperative values at POD 2. Conclusions. In contrast with PCA management, TEA using low concentrations of bupivacaine and fentanyl blunted cardiac sympathetic neural drive, resulting in vagal predominance, while HRV variables were better restored after surgery. Br J Anaesth 2003; 91: 525‐31
Databáze: OpenAIRE
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