High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart
ABSTRACT In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease.
The effect of a high epidural block (at least Th1-Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E'') and atrial (A'') peak velocities during diastole.
After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 +/- 1.53 to 6.86 +/- 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E''/A'' ratio increased from 0.75 +/- 0.27 to 1.09 +/- 0.32 (P=0.0026), indicating improved relaxation.
A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.
- Acta Anaesthesiologica Scandinavica 06/2009; 53(5):556-8. DOI:10.1111/j.1399-6576.2009.01956.x · 2.31 Impact Factor
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ABSTRACT: Approach of the epidural space is different at the thoracic level due to a more acute angle of spinous processes that varies from 25° to 45° from T4 to T10. Thoracic epidural volume is less important. Epidural pressure is more negative at the level of upper segments. Thoracic epidural space can be identified by the hanging drop technique or by loss of resistance to saline. The haemodynamic consequences of a thoracic block (bradycardia, hypotension, decrease of left ventricle inotropism) are mild when the extension of the block is limited; a more extended block related to lower thoracic segments injections may induce splanchnic block and venous blood sequestration. Thoracic epidural anaesthesia improves myocardial oxygen balance in patients with myocardial ischaemia. Local anaesthetic administration into the thoracic epidural space improves postoperative respiratory mechanical dysfunction and shortens the duration of postoperative ileus. Continuous administration of a local anaesthetic combined with a lipid soluble opioid guarantees a good quality analgesia.Le Praticien en Anesthésie Réanimation 11/2009; 13(5). DOI:10.1016/j.pratan.2009.09.003
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ABSTRACT: Ketamine may be followed by a general increase in haemodynamics and oxygen consumption, which may be of concern in patients with ischaemic heart disease. The purpose of this study was to evaluate the effect of ketamine on left ventricular (LV) systolic and diastolic function by different modalities of echocardiography and tissue Doppler imaging in patients with ischaemic heart disease. Prospective observational study of 11 patients acting as own control based on echocardiographic imaging before and after bolus ketamine 0.5 mg/kg. Simpson's 2 D-volumetric method was used to quantify left ventricular volume and ejection fraction. General global LV deformation was assessed by Speckle tracking ultrasound, systolic LV longitudinal displacement was assessed by Tissue Tracking score index and the diastolic function was evaluated from changes in early-(E') and atrial (A') peak velocities during diastole. Average heart rate (34%) and blood pressure (35%) increased significantly after ketamine (P<0.0001). Mean tissue tracking score index decreased from 11.2 ± 2.3 to 8.3 ± 2.6 (P=0.005) and Global Speckle tracking 2D strain from 17.7 ± 2.7 to 13.7 ± 3.6 (P=0.0014) indicating a decrease in LV global systolic function. The E'/A' ratio decreased from 1.11 ± 0.43 to 0.81 ± 0.46 (P=0.044) indicating impaired relaxation. Different modalities of echocardiography in combination with tissue Doppler indicate both diminished systolic and diastolic function after ketamine administration in patients with ischaemic heart disease.Acta Anaesthesiologica Scandinavica 10/2010; 54(9):1137-44. DOI:10.1111/j.1399-6576.2010.02283.x · 2.31 Impact Factor