Abstract
BackgroundThoracic epidural anesthesia (TEA) exacerbates hypotension due to peripheral vasodilator effects following the use of general anesthetics. This study aimed to compare the hemodynamic changes caused by three different concentrations of epidural ropivacaine and to evaluate the performance of the stroke-volume variation (SVV) and central venous pressure (CVP) during TEA with general anesthesia.MethodsA total of 120 patients were administered 8 mL of ropivacaine solution via epidural injection, following randomization into one of three groups based on the concentration of ropivacaine in the study solution: 0.75%, 0.375%, or 0.2%. Hemodynamics were monitored for 30 min after loading. We analyzed the hemodynamic changes in the subgroups according to an age cutoff of 60 years. Receiver operating characteristic (ROC) analysis was performed to characterize the relationship of the SVV, CVP, and a 20% decrease in the mean arterial pressure (MAP) following TEA.ResultsData from 109 patients were analyzed. MAP and systemic vascular resistance index were significantly decreased, and SVV was significantly increased after epidural loading only in the 0.75% ropivacaine group. There was a significant difference in hemodynamics between young and elderly subgroups in the 0.75% ropivacaine group. SVV showed a negative correlation with MAP, whereas CVP showed no correlation. The ROC analysis of SVV demonstrated a weak predictive ability of a 20% decrease in MAP at 10 min after the loading dose, with an area-under-the-curve of 0.687 and a 9.5% optimal cutoff value (sensitivity, 60.6%; specificity, 68.9%).ConclusionsA high concentration of ropivacaine through TEA caused a significant decrease in the systemic vascular resistance and blood pressure. More significant decreases were shown in the elderly patients. Though the change of SVV showed a negative correlation with hypotension and indicated functional hypovolemia after TEA, the predictability was limited.Clinical trials registrationNumber: NCT01559285, date: January 24, 2013.
Highlights
Thoracic epidural anesthesia (TEA) exacerbates hypotension due to peripheral vasodilator effects following the use of general anesthetics
In the 0.75% ropivacaine group, there was significantly decreased mean arterial pressure (MAP), systemic vascular resistance index (SVRI), and significantly increased stroke-volume variation (SVV) compared with those in the 0.375% and 0.2% groups
In our study, we found the followings: 1) Significantly decreased MAP after epidural administration of ropivacaine was observed at a concentration of 0.75% ropivacaine, but not at concentrations of 0.375% and 0.2% ropivacaine, 2) A reduction in SVR and an increase in SVV showed a significant correlation with a decrease of MAP, but central venous pressure (CVP) did not, 3) In elderly patients, hypotension in the high concentration group was more prevalent and the accompanying SVV
Summary
Thoracic epidural anesthesia (TEA) exacerbates hypotension due to peripheral vasodilator effects following the use of general anesthetics. This study aimed to compare the hemodynamic changes caused by three different concentrations of epidural ropivacaine and to evaluate the performance of the stroke-volume variation (SVV) and central venous pressure (CVP) during TEA with general anesthesia. Combining thoracic epidural analgesia (TEA) with general anesthesia has been widely used for perioperative treatment in patients undergoing major upper abdominal surgery. Hemodynamic impairments accompanying TEA with general anesthesia are affected by various factors. The most common physiologic consequence of epidural anesthesia is hypotension, primarily due to the sympathetic nervous system block [6], clinical studies on hemodynamic effects of epidural local analgesic-related dose titration leading to different cardiovascular responses have not been well-studied
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