Summary
The cardio-respiratory effects of an epidural anaesthetic given to 13 subjects pre-operatively are reported. They were fasting, unpremedicated and supine. A sensory block up to the 4th thoracic segment was not followed by any significant change in frc, fev1, vc, A-aDo2, Qs/Qt or cardiac output.
Résumé
Les auteurs rapportent leurs observations sur les effets cardio-respiratoires lore d’une anesthésie péridurale thoracique haute (au niveau du t4), Leur rapport est surtout concentré sur la capacité résiduelle fonctionnelle (crf) et le gradient alvéolo-artériel de PO2 (A-aDo2), ces paramétres n’étant pas rapportés dans la litérature à date. Les cas étudiés étaient 13 candidats à la chirurgie abdominale haute. Ils rapportent des changements sans importance clinique ou statistique dans la capacité vitale (cv), crf, fev i.o de même que dans le A-aDo2, le shunt (Qs/QT) et débit cardiaque (Qc) ainsi que dans le rapport vd/vt. Ces observations suivirent une hydratation adéquate (10 ml/kg de dextrose à 5 pour cent dans sérum physiologique), Temploie de lidocaine 1.5 pour cent et un dosage qs pour atteindre une analgésie à la piqûre et à la glace de t4 seulement.
En conclusion ils soulignent l’importance des précautions à prendre vis-à-vis le dosage et l’iydration pour en arriver à un résultat clinique satisfaisant de cette technique.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Bromage, P. R. Extradural analgesia for pain relief. Brit. J. Anaesth.,39: 721 (1967).
Simpson, B. R., Parkhouse, J., Marshall, R., &Lambsechts, W. Extradural analgesia and the prevention of post-operative pulmonary complications. Brit. J. Anaesth.,33: 628 (1961).
Muneyuki, M., Ueda, Y., Urabe, N., Takeshita, H., &Inamoto, A. Post-operative pain relief and respiratory function in man. Anesthesiology,29: 304 (1968).
Browne, R. A. &Ashwobth, E. J. The use of epidural block in acute pancreatitis: A report of eight cases. Canad. Anaesth. Soc. J.,16: 416 (1969).
Bhomage, P. R. Continuous lumbar epidural analgesia for obstetrics. Canad. M. A. J.,85: 1136 (1961).
Cleland, J. G. P. Continuous peridural and caudal analgesia in surgery and early ambulation. Northwest Med. (Seattle),48: 126 (1949).
Bromage, P. R. Physiology and pharmacology of epidural anesthesia. Anesthesiology,28: 592 (1967).
Moir, D. D. Ventilatory function during epidural analgesia. Brit. J. Anaesth.,35: 3 (1963).
Moir, D. D. &Mone, J. G. Acid-base balance during epidural analgesia. Brit. J. Anaesth.,36: 480 (1964).
Stephen, G. W., Lees, M. M., &Scott, D. B. Cardiovascular effects of epidural block combined with general anaesthesia. Brit. J. Anaesth.,41: 933 (1969).
Freund, F. C., Bonica, J. J.,Ward, R. J., Akamatsu, T. S., &Kennedy, W. F. Ventilatory reserve and level of motor block during high spinal and epidural anesthesia. Anesthesiology,28: 834 (1967).
Wabd, R. J., Bonica, J. J., Freund, F. C., Akamatsu, T. S. Danzicer, F., &Enclesson, S. Epidural and subarachnoid anesthesia: Cardiovascular and respiratory effects, J.A.M.A.,191: 99 (1985).
Otton, P. E. &Wilson, E. J. The cardioeirculatory effects of upper thoracic epidural analgesia. Canad. Anaesth. Soc. J.,13: 541 (1966).
Mclean, A. P. H., Mulligan, G. W., Otton, P. E., &MacLean, L. D. Hemodynamic alterations associated with epidural anesthesia. Surgery,61: 79 (1967).
Defalque, R. J. Compared effects of spinal and extradural anesthesia upon blood pressure. Anesthesiology,23: 627 (1962).
Meneely, G. F. &Kaltfeider, N. L. The volume of the lung determined by helium dilution. Description of the method and comparison with other procedures. J. Clin. Invest.28: 129 (1949).
Hamilton, W. F., Moore, J. W., Krasman, J. M. &Spurlinc, R. G. Studies on the circulation iv. Am. J. Physiol.,99: 534 (1932).
Nunn, J. W. Applied Respiratory Physiology, with Special Reference to Anaesthesia. Butterworth London, 1969, p. 262.
Campbell, E. J. M. An electromyographic examination of the role of the intercostal muscles in breathing in man. J. Physiol, (Lond.),129: 12 (1955).
Campbell, E. J. M., The respiratory muscles and the mechanics of breathing, 1958, London: Lloyd-Luke.
Morris, D. D. B. Spinal and epidural analgesia: technique and complications, in “A Practice of Anaesthesia” (eds: Wylie, W. D. and Churchill-Davidson, H. C.) London: Lloyd-Luke, (Ed. II, p. 1048).
Craic, D. B. Effects of airway closure on pulmonary gas exchange, msc Thesis (Experimental Medicine) McGill University, Montreal.
Leblanc, P., RUFf, F., &Milic-Emili, J. Effects of age and body position on airway closure in man. J. Appl. Physiol.,28: 448–451 (1970).
Anscombe, A. R. Pulmonary Complications of Abdominal Surgery. Chicago, Year Book Medical Publishers 1957.
Beecher, H. K. P. Effect of Laparotomy on lung volumes. J. Clin, Invest.12: 651 (1933).
Bonica, J. J., Kennedy, W. F., Ward, R. J., &Tolas, A. G. A comparison of the effects of high subarachnoid and peridural anaesthesia, Acta scandinav. Anaesth. Supp.,23: 429 (1966).
Wugmeister, M. &HeKre, F. W., The absence of differential blockade in epidural anaesthesia. Brit. J. Anaesth.,39: 953 (1967).
Greene, N. M. The area of differential blockade during spinal anesthesia with hyperbaric tetracaine. Anesthesiology,19: 45 (1958).
Ciba Collection of Medical Illustrations., Vol. 5, p. 18.
Wood-Smith, Stewart &VickErs: In Drugs in Anaesthetic Practice. Ed. in Butterworths, 1968, p. 194.
Bonica, J. J., Berges, P. U., &Momkawa, K. Circulatory effects of peridural block I: effects of level of analgesia and dose of lidocaine. Anesthesiology,33: 619 (1970).
Author information
Authors and Affiliations
Additional information
Work completed in partial fulfillment to the requirements for à msc, Experimental Medicine, Faculty of Graduate Studies and Research, McGill University and supported by mrc, Canada.
Rights and permissions
About this article
Cite this article
Wahba, W.M., Craig, D.B., Don, H.F. et al. The cardio-respiratory effects of thoracic epidural anaesthesia. Canad. Anaesth. Soc. J. 19, 8–19 (1972). https://doi.org/10.1007/BF03006903
Issue Date:
DOI: https://doi.org/10.1007/BF03006903