Haemodynamic effects of thoracic epidural anaesthesia during induction of anaesthesia: an investigation into the effects of tracheal intubation during target‐controlled infusion of propofol*

Abstract

SummaryWe compared haemodynamic changes following induction of anaesthesia with propofol during tracheal intubation with and without epidural anaesthesia. Nineteen patients were divided into two groups to receive epidurally administered saline (Group C) or lidocaine 1.5% (Group E). The propofol infusion was started to produce blood concentrations of 3 lg.ml )1 , and following fentanyl and vecuronium administration, tracheal intubation was performed. Mean arterial blood pressure (MBP), heart rate (HR), Bispectral index and effect-site propofol concentration were recorded. Time to loss of consciousness was significantly shorter in Group E than in Group C. The effect-site propofol concentration at loss of consciousness was significantly lower in Group E than in Group C. MBP and HR were significantly lower following propofol induction in both groups, and were significantly increased following intubation in Group C but not in Group E. In conclusion, epidural anaesthesia did not produce profound hypotension following induction of anaesthesia and produced a reduction in the haemodynamic response to tracheal intubation during a target controlled infusion of propofol.

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

“…Both 1.5% lidocaine and 0.5% ropivacaine were associated with a reduced increase in MABP post-intubation. Our findings of hemodynamic changes during general anesthesia combined epidural/general anesthesia are consistent with the recent work of Nakatani et al(2005). The mechanism of hemodynamic changes caused by laryngoscopy and intubation is considered to be somato-visceral reflexes (Hassan et al, 1991), associated with catecholamines releasing from the adrenal gland.…”

“…Laryngoscopy and tracheal intubation are thought to be the strongest noxious stimuli during the course of general anesthesia and are often associated with hemodynamic changes including tachycar-dia, hypertension and increases in the plasma concentration of catecholamines (Shribman et al, 1987;Achola et al, 1988). Nakatani et al(2005) investigated hemodynamic changes following induction of anesthesia with propofol during tracheal intubation with or without epidural anesthesia and found that epidural anesthesia did not produce profound hypotentension following induction of anesthesia and produced a reduction in the hemodynamic response to tracheal intubation during a target controlled infusion of propofol.…”

Effects of General-epidural Anaesthesia on the Hemodynamics in Patients with Myasthenia Gravis

“…This phenomenon was caused by the fact that the sympathetic efferent nerve fibres governing the thoracic and abdominal vascular bed originate from the spinal cord between T1 and T3. A thoracic epidural anaesthesia blocks the splanchnic sympathetic nerves in this region and this sympathetic nerve blocking effect antagonizes the sympathetic-catecholamine source vasoconstriction caused by surgical stress, expands part of the vessels, and reduces the quantity of catecholamine released into blood from sympathetic nerve endings (15)(16)(17). Furthermore, the GEA group had a markedly better analgesic effect than the GA group and the latter group had to add the dosages of propofol and fentanyl and increase the concentration of inhaled sevoflurane to meet the requirements for the operation.…”

Effects of epidural anesthesia with 0.2% and 1% ropivacaine on predicted propofol concentrations and bispectral index values at three clinical end points

“…Hodgson and Liu [2] applied TES to patients who received epidural or intravenous lidocaine or epidural saline, and found that lidocaine epidural anesthesia reduced the minimum alveolar concentration of sevoflurane by 50%. We also found that thoracic epidural anesthesia decreased hemodynamic changes during induction of anesthesia using propofol in target-controlled infusion [12].…”