Thoracic, but not lumbar, epidural anesthesia improves cardiopulmonary function in ovine pulmonary embolism

Citation
Ur. Jahn et al., Thoracic, but not lumbar, epidural anesthesia improves cardiopulmonary function in ovine pulmonary embolism, ANESTH ANAL, 93(6), 2001, pp. 1460-1465
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIA AND ANALGESIA
ISSN journal
0003-2999 → ACNP
Volume
93
Issue
6
Year of publication
2001
Pages
1460 - 1465
Database
ISI
SICI code
0003-2999(200112)93:6<1460:TBNLEA>2.0.ZU;2-Q
Abstract
We hypothesized that sympathetic stimulation is the main mechanism contribu ting to hemodynamic failure in pulmonary embolism. We investigated the effe cts of epidural anesthesia-induced sympathetic blockade, restricted to thor acic and lumbar levels, during pulmonary embolism. Two experiments were per formed in chronically instrumented ewes. In the first experiment, six sheep received 6 mL bupivacaine 0.175% (Thoracic Epidural Anesthesia [TEA] group ), and six sheep received 6 mL saline 0.9% (TEA-Control group), respectivel y, via an epidural catheter (T3 level). In the second experiment, six sheep received 2.8 mL bupivacaine 0.375% (Lumbar Epidural Anesthesia [LEA] group ), and six sheep received 2.8 mL saline 0.9% (LEA-Control group) epidurally (L4 level). Embolization was performed by IV injection of autologous blood clots (Experiment 1, 0.75 mL/kg; Experiment 2,0.625 mL/kg). TEA was associ ated with significantly slower heart rates, decreased mean pulmonary artery pressures and central venous pressures, and significantly higher stroke vo lume index and oxygenation in comparison with the TEA-Control group. By con trast, LEA was associated with significantly faster heart rates and increas ed central venous pressures and with a significantly lower stroke volume in dex in comparison with the LEA-Control group. TEA significantly reduced, an d LEA significantly increased, hemodynamic deterioration, suggesting benefi cial effects of TEA on cardiopulmonary function during pulmonary thromboemb olism.