Thoracic Epidural Anesthesia In Patients Research Articles

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

ObjectiveA mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI2)-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.DesignRandomized, blinded controlled trial.SettingSingle-center university hospital.ParticipantsFifty patients undergoing open esophagectomy.InterventionsPatients 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-PGF1α, a stable metabolite of PGI2 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.ResultsForty-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-PGF1α by 15 min of surgery and plasma IL6 (p<0.001) as C-reactive protein (P<0.009) increased. EA TEA influenced the amount of phenylephrine needed to maintain mean arterial pressure >60 mmHg in patients who developed MTS (0.16 [0.016–0.019] mg/min vs MTS and LA TEA 0.000 [0.000–0.005] mg/min, p<0.001).ConclusionThe incidence of MTS is not prevented by TEA in patients undergoing open esophagectomy. On the contrary, the risk of hypotension is increased in patients exposed to TEA during surgery, and the results suggest that it is advantageous to delay activation of TEA. Also, MTS seems to be associated with a systemic inflammatory response, maybe explaining the aggravated post-operative outcome.

Effectiveness of thoracic epidural anesthesia in reducing morbidity and mortality in adults with acute pancreatitis: a systematic review protocol and meta-analysis.

The objective of this review is to evaluate the effectiveness of thoracic epidural in reducing morbidity and mortality in adults with acute pancreatitis. Acute pancreatitis is a common disease that often results in significant morbidity and mortality. Although the use of a thoracic epidural anesthesia in patients with acute pancreatitis provides effective analgesia, there appears to be additional non-analgesic benefits associated with thoracic epidural anesthesia. Randomized controlled trials will be sought for inclusion, but this review will also consider quasi-experimental studies, cohort studies, case-controlled studies, cross-sectional studies, and case-series studies. Studies will include patients 18 years of age and older with acute pancreatitis, with no exclusion to comorbidity. Studies published in a language other than English will be excluded unless a translated version is available. The key databases to be searched include MEDLINE, CINAHL, OpenGrey, ClinicalTrials.gov, and Google Scholar. Studies will be assessed for inclusion by at least two independent reviewers. Included studies will be critically appraised by two independent reviewers using standardized critical appraisal instruments from JBI. Data will be extracted from studies included in the review using a standardized extraction tool. Studies will, where possible, be pooled in statistical meta-analysis using JBI SUMARI. The title of this protocol has been registered with the JBI Systematic Review Register. This manuscript has been registered with PROSPERO (CRD42020177756).

Analgesic efficacy of erector spinae block in comparison to thoracic epidural anesthesia in patients undergoing transthoracic esophageal surgical procedure

Background The ultrasound-guided erector spinae plane block is a new regional anesthetic technique providing long-lasting excellent analgesia in addition to hemodynamic stability and minimal rescue analgesic request. Materials and methods Following ethics committee approval, a total of 80 patients aged 36–65 years, American Society of Anesthesiologists physical status I and II undergoing elective transthoracic esophageal surgical procedures were enrolled in this prospective study. The patients were randomized into epidural group: patients who received thoracic epidural anesthesia with injection of 15 ml of bupivacaine 0.25% combined with general anesthesia, followed by 7 ml/h of 0.125% bupivacaine and bilateral erector spinae block group, which were performed with an injection of a total of 15 ml of bupivacaine 0.25% on either side combined with general anesthesia and then 7 ml/h of 0.125% bupivacaine was injected in each catheter 2 h for 24 h postoperatively. The primary end point included postoperative minor complications (hypotension, vomiting, urinary retention) and major complications (mortality). Secondary end points included the extubation time, hospital stay length, pain scores at 4, 8, 12, 18, and 24 h postoperatively, rescue analgesic consumption and patient satisfaction scores. Results Pain scores and the total dose of rescue analgesic were comparable in the two groups. The length of hospital stay was significantly longer in the epidural group compared with the erector group. Satisfaction scores were significantly higher in the erector group compared with the epidural group. There was no significant difference between the study groups regarding time to perform the block, time to extubation, and incidence of postoperative complications except for hypotension which was significantly higher in the epidural group. Conclusion Erector spinae plane block has an outstanding beneficial effect in reducing pain and providing better satisfaction scores with less incidence of complications compared with thoracic epidural anesthesia.

Comparison of the Effects of Thoracic Epidural Anesthesia with General Anesthesia on Hemodynamic Changes and its Complications in Patients Undergoing Laparoscopic Cholecystectomy.

Background:Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy.Materials and Methods:This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t-test and Chi-square tests.Results:The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant (P < 0.05) between the two groups at 4, 6, and 12 h after anesthesia and it was higher in a group of GA. There was no significant difference in shivering and itching between the two groups (P > 0.05).Conclusion:The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approach.

Discussion of: Efficacy and safety of transversus abdominis plane block versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective, randomized controlled trial

Discussion of: Efficacy and safety of transversus abdominis plane block versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective, randomized controlled trial

Efficacy and safety of transversus abdominis plane blocks versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective, randomized controlled trial

BackgroundThe purpose of this study was to compare patient outcomes for thoracic epidural anesthesia (TEA) with transversus abdominis plane (TAP) blocks. MethodsA prospective, randomized trial was performed for patients undergoing abdominal oncologic surgeries. ResultsThere were 32 TAP and 35 TEA subjects. The TEA group demonstrated increased episodes of hypotension in the first 24 h (3 v 0.6, p = 0.02). There was no difference in 24–48 h fluid balance between the groups. Overall parenteral morphine equivalents of opioids administered for the TEA group were higher for each postoperative day (p < 0.05). The post-operative survey did not demonstrate any difference in subjective pain between the TAP and TEA groups (6 v 6 p = 0.35). There was no attributable morbidity associated with either technique. ConclusionsTAP block use was associated with lower parenteral morphine equivalent usage and decreased incidence of hypotension in the early post-operative period compared to TEA.

High thoracic epidural anesthesia in patients with synchronous carotid endarterectomy and off-pump coronary artery revascularization

In order to reduce the risk of cerebrovascular insults (CVI), the latest recommendations suggest that carotid endarterectomy (CEA) is strongly indicated in patients scheduled for coronary surgery when significant carotid artery stenosis is symptomatic and/or bilateral. The best results are obtained in small studies with CEA performed immediately prior to off-pump coronary bypass (OPCAB). We present 16 consecutive patients who underwent synchronous CEA and OPCAB under general anesthesia combined with high thoracic epidural anesthesia (TEA) in order to evaluate the safety and potential benefits of such anesthetic management. A total of 16 consecutive patients scheduled for simultaneous CEA and OPCAB with no contraindication for TEA were enrolled in the study. All the patients were anesthetized with TEA combined with general anesthesia. Early extubation was planed in all the patients for early assessment of neurological outcome. Demographics, comorbidity, quality of postoperative recovery, duration of mechanical ventilation, successful early extubation, outcome, length of Intensive Care Unit (ICU) and hospital stay were recorded. Only two patients did not fulfill the criteria for early extubation. The average duration of mechanical ventilation for patients who fulfilled criteria for early extubation was 87.9 +/- 85.0 (0-255) min. Five (31.25%) patients were extubated in the operating theater at the end of surgery. There were no deaths, nor neurological complications of TEA. Seven (43.7%) patients had at least one of the postoperative complications considered significant. None of them had CVI. None of the early extubated patients was reintubated or had postoperative respiratory failure. Our study revealed that a combination of general anesthesia with TEA appears to be good choice in synchronous CEA and OPCAB due to advantages of early extubation and early neurological assessment. Larger studies are necessary to determine real benefits on both short and long-term outcomes of such anesthetic management in synchronous CEA and OPCAB.

Meta-analysis of Thoracic Epidural Anesthesia versus General Anesthesia for Cardiac Surgery

A combination of general anesthesia (GA) with thoracic epidural anesthesia (TEA) may have a beneficial effect on clinical outcomes after cardiac surgery. We have performed a meta-analysis to compare mortality and cardiac, respiratory, and neurologic complications in patients undergoing cardiac surgery with GA alone or a combination of GA with TEA. Randomized studies comparing outcomes in patients undergoing cardiac surgery with either GA alone or GA in combination with TEA were retrieved from PubMed, Science Citation index, EMBASE, CINHAL, and Central Cochrane Controlled Trial Register databases. The search strategy yielded 1,390 studies; 28 studies that included 2,731 patients met the selection criteria. Compared with GA alone, the combined risk ratio for patients receiving GA with TEA was 0.81 (95% CI: 0.40-1.64) for mortality, 0.80 (95% CI: 0.52-1.24) for myocardial infarction, and 0.59 (95% CI: 0.24-1.46) for stroke. The risk ratios for the respiratory complications and supraventricular arrhythmias were 0.53 (95% CI: 0.40-0.69) and 0.68 (95% CI: 0.50-0.93), respectively. This meta-analysis showed that the use of TEA in patients undergoing cardiac surgery reduces the risk of postoperative supraventricular arrhythmias and respiratory complications. The sparsity of events precludes conclusions about mortality, myocardial infarction, and stroke, but the estimates suggest a reduced risk after TEA. The risk of side effects of TEA, including epidural hematoma, could not be assessed with the current dataset, and therefore TEA should be used with caution until its benefit-harm profile is further elucidated.

Thoracic epidural anesthesia in patients with cytoreductive surgery and HIPEC

Journal of Surgical OncologyVolume 102, Issue 5 p. 545-546 Letter to the Editor Thoracic epidural anesthesia in patients with cytoreductive surgery and HIPEC C. Schmidt MD, PhD, Corresponding Author C. Schmidt MD, PhD christoph_schmidt2001@yahoo.de Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanyDepartment of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, Germany. Fax: +49-345-557-3328.Search for more papers by this authorT. Steinke MD, T. Steinke MD Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanySearch for more papers by this authorS. Moritz MD, S. Moritz MD Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanySearch for more papers by this authorM. Bucher MD, PhD, M. Bucher MD, PhD Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanySearch for more papers by this author C. Schmidt MD, PhD, Corresponding Author C. Schmidt MD, PhD christoph_schmidt2001@yahoo.de Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanyDepartment of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, Germany. Fax: +49-345-557-3328.Search for more papers by this authorT. Steinke MD, T. Steinke MD Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanySearch for more papers by this authorS. Moritz MD, S. Moritz MD Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanySearch for more papers by this authorM. Bucher MD, PhD, M. Bucher MD, PhD Department of Anaesthesiology and Operative Intensive Care Medicine, Hospital of the University of Halle (Saale), Ernst-Grube-Strasse, 40 06120 Halle/Salle, GermanySearch for more papers by this author First published: 06 July 2010 https://doi.org/10.1002/jso.21660Citations: 13Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume102, Issue51 October 2010Pages 545-546 RelatedInformation

High thoracic epidural anesthesia and coronary artery disease in surgical and non-surgical patients

Even though high thoracic epidural anesthesia has been shown to be highly efficacious in the control of symptoms in refractory angina, its general use is still restricted. In patients who undergo coronary revascularization, however, the technique is becoming more and more popular. The present review outlines the use of high thoracic epidural anesthesia in patients with ischemic heart disease who underwent coronary revascularization in order to further reveal high thoracic epidural anesthesia's low complication rate and to analyze why physicians still refrain from using it more frequently. The incidence of severe hemodynamic complications after high thoracic epidural anesthesia is low in patients with coronary artery disease. The main advantage would be a myocardial sympathectomy leading to an improvement in the oxygen input-demand relationship. Likewise, a decrease in mortality due to respiratory complications could not be shown. In patients undergoing myocardial revascularization with full anticoagulation there is an increased risk of epidural hematoma formation. Its precise risk is difficult to evaluate. There is an overall low rate of epidural hematomas as a result of high thoracic epidural anesthesia. With the available data, the incidence has been estimated at between 1/1500 and 1/10,000. Epidural anesthesia does not decrease mortality or the incidence of myocardial infarction after coronary artery bypass grafting. It reduces the incidence of arrhythmias and respiratory complications and improves the quality of analgesia. High thoracic epidural anesthesia has been shown to be a safe and efficient technique for refractory angina that reduces the frequency of ischemic events and improves the clinical condition of patients.

Temporary neurologic deficits in patients undergoing cardiac surgery with thoracic epidural supplementation

s a e c w a t d d C s ENERAL ANESTHESIA (GA) remains the most common and preferred method of anesthesia for patients unergoing cardiac surgery. However, hemodynamic responses to racheal intubation, suction of the endotracheal tube, and extuation may lead to myocardial ischemia and increase the risk of yocardial infarction in patients with coronary artery disase.1,2 Thoracic epidural anesthesia (TEA) may also be used as n adjunct to GA or as the sole anesthetic during coronary rtery bypass graft surgery.3 Thus, detrimental hemodynamic hanges that may occur during GA alone may be avoided by sing TEA.4 Supplementation of GA with TEA may also proide improved conditions for coronary artery bypass surgery by ilating the coronary arteries and the internal mammary arteres.3 Additional potential advantages of TEA include enhanced nalgesia, improved pulmonary function, facilitation of extuation, and decreased cardiac arrhythmias during the intraoprative and immediate postoperative period. The potential disadvantages of using TEA include risk of ematoma formation, neurologic injury, and infection. The fear f epidural hematoma and neurologic injury weighs heavily on he minds of clinicians when epidural anesthesia is used, alhough epidural hematoma during cardiac surgery has not (yet) een reported. However, it is unlikely that clinicians will idely adopt the use of TEA in patients undergoing cardiac

High thoracic epidural anesthesia in coronary surgery

High thoracic epidural anesthesia and analgesia are being increasingly used for coronary artery bypass graft surgery. The reasons for this include excellent perioperative pain control with advantage of early tracheal extubation, improved postoperative pulmonary function, and cardiac protection due to sympthatetic blockade. Cardiac protection is the consequence of decreased heart rate, myocardial contractility and arterial blood pressure, without changes in coronary perfusion pressure. Therefore, high thoracic epidural analgesia beneficially alters major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. In addition, decrease of functional residual capacity, may reduce postoperative pulmonary morbidity. Patients with high thoracic epidural anesthesia revealed a more favourable perioperative hemodynamic profile, lower incidence of ischemia and better response to perioperative stress. The epidural catheter should be placed at the Th2/Th3 interspace at least one hour before administration of heparin. After local anesthetic bolus dose, a continuous epidural infusion is recommended. There is strong evidence for beneficial effects of high thoracic epidural anesthesia in patients undergoing surgical myocardial revascularization. However, it is still underutilized in current clinical practice.

Case 2—2002 thoracic epidural anesthesia in patients with ankylosing spondylitis undergoing coronary artery surgery

Case 2—2002 thoracic epidural anesthesia in patients with ankylosing spondylitis undergoing coronary artery surgery

Lumbar spine fusion performed with hypotensive thoracic epidural anesthesia

The technique of hypotensive epidural anesthesia for lumbar spine fusion is described. The major benefit is reduced blood loss. The other is early emergence from general anesthesia and the option for postoperative thoracic epidural analgesia. This technique requires skill at thoracic epidural anesthesia in patients with deformed spines, facility at performing hemodynamic monitoring, and a preparedness to closely monitor patients intraoperatively to optimize their physiology.

Thoracic Epidural Anesthesia and the Patient with Heart Disease

Thoracic Epidural Anesthesia and the Patient with Heart Disease

Long-Term Home Self-Treatment with High Thoracic Epidural Anesthesia in Patients with Severe Coronary Artery Disease

Long-Term Home Self-Treatment with High Thoracic Epidural Anesthesia in Patients with Severe Coronary Artery Disease

Long-Term Home Self-Treatment with High Thoracic Epidural Anesthesia in Patients with Severe Coronary Artery Disease

Twenty patients with severe coronary artery disease (CAD) and refractory unstable angina who had sustained a recent myocardial infarction (n = 7) or who were considered as either inoperable (n = 10) or at severe operative risk (n = 3) were treated with high thoracic epidural anesthesia (TEA) via a tunneled epidural catheter for long-term self-use at home. They were instructed to use sublingual nitrates as their first treatment for angina and to inject 3-5 mL of bupivacaine (5 mg/mL) into the epidural catheter only for severe episodes. The epidural catheters were maintained for long periods (mean, 6 mo; longest treatment, 3.2 yr). Most patients expressed great satisfaction with the TEA treatment. The epidural bupivacaine injections induced complete pain relief within a short period. There were no severe adverse events induced by the treatment, and only one case of tachyphylaxis was documented. There was a decrease in the frequency of epidural injections with time from an average of 1.86 +/- 0.5 to 0.96 +/- 1.1 injections/d from the first to the last week of treatment (n = 18) (P < 0.001). This decrease was most evident when comparing the last week of TEA treatment in patients having TEA < 1 mo (n = 5) with patients having TEA > 6 mo (n = 5), an average of 2.00 +/- 0.47 vs 0.25 +/- 0.10 injections/d, respectively (P < 0.01). Seven patients had either coronary bypass surgery (n = 6) or spinal cord electrical stimulation (n = 1) after an average of 42 days of successful TEA treatment (range, 14-70 days).(ABSTRACT TRUNCATED AT 250 WORDS)