Observations on significant hemodynamic changes caused by a high concentration of epidurally administered ropivacaine: correlation and prediction study of stroke volume variation and central venous pressure in thoracic epidural anesthesia

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.

Epidural and Non-epidural Analgesia in Patients Undergoing Open Pancreatectomy: a Retrospective Cohort Study

“…Moreover, previous studies and our study showed the association between EA and perioperative hemodynamic instability, leading to early termination in 7–41% of EA (10.5% in our study). 5–8,26,27 The higher cumulative fluid balances on PODs 1–3 in the EA group can be explained by the switch from vasoactive medication at the MC/IC to fluid therapy on the surgical ward to ensure adequate hemodynamic status. We hypothesize that excessive fluid therapy on the surgical ward is needed as long as the EA phase is prolonged.…”

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study

“…The anesthesia manipulation was conducted according to the attending anesthesiologist's discretion. Since high concentration of epidurally administrated ropivacaine may cause a significant hemodynamic change [12,13], anesthesiologists in our medical center prefer to delivered lower concentration of ropivacaine in elder patients for more stable hemodynamic and to reduce potential perioperative cardiovascular complications Meanwhile, higher epidural ropivacaine concentration provided not only regional analgesia but also a better relaxation of abdominal muscles [14][15][16]. Thus, anesthesiologists in our medical center prefer to administrate high dose of ropivacaine in patients who received radical, complicated and time-consuming surgeries, such as pancreaticoduodenectomy in the present study.…”

The Median Effective Concentration (EC50) of Epidural Ropivacaine With Different Doses of Oxycodone During Limb Surgery in Elderly Patients

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