High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart

ArticleinActa Anaesthesiologica Scandinavica 53(5):559-64 · May 2009with7 Reads
Impact Factor: 2.32 · DOI: 10.1111/j.1399-6576.2009.01939.x · Source: PubMed
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.

    • "...kyriuje trukmę, o kiti tyrimai teigia, kad ši metodika naudinga pacientams su išemine širdies liga [13]. Darbo tikslas. ..."
      [10] atliktas tyrimas nustatė, kad epiduralinė anestezija abdominalinėje chirurgijoje gerina baigtis didesnės rizikos pacientams. Jau yra įrodymų, kad HTEA trumpina nutukusių [11] ir senyvo amžiaus pacientų [12] gulėjimo intensyvios terapijos skyriuje trukmę, o kiti tyrimai teigia, kad ši metodika naudinga pacientams su išemine širdies liga [13]. Darbo tikslas.
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    • "...ence cardiaque peut ainsi protéger contre les contraintes ventriculaires systolique et diastolique [29]. Au total, on peut retenir que l'APDT limitée au métamères thoraciques réduit faiblement la pressio..."
      Enfin chez des patients coronariens, l'APDT peut améliorer la perfusion coronaire et réduire l'ischémie myocardique [27,28] (Fig. 7). La conjonction d'un contrôle strict de la douleur, de la stimulation sympathique, de la fréquence cardiaque peut ainsi protéger contre les contraintes ventriculaires systolique et diastolique [29]. Au total, on peut retenir que l'APDT limitée au métamères thoraciques réduit faiblement la pression artérielle, la fréquence cardiaque, augmente le débit sanguin coronaire même en présence de lésion athéromateuse, réduit la consommation en O 2 , les scores de douleurs et le tonus sympathique.
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Nov 2009 · Le Praticien en Anesthésie Réanimation
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  • No preview · Article · Jun 2009 · Acta Anaesthesiologica Scandinavica
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