High Thoracic Epidural Anesthesia, but Not Clonidine, Attenuates the Perioperative Stress Response Via Sympatholysis and Reduces the Release of Troponin T in Patients Undergoing Coronary Artery Bypass Grafting

Loick, H. M.; Schmidt, Christoph; Aken, Hugo Van; Junker, Ralf; Erren, Michael; Berendes, Elmar; Rolf, Norbert; MeiBner, Andreas; Schmid, Christoph; Scheld, Hans H.; Möllhoff, T.

doi:10.1213/00000539-199904000-00001

Cited by 188 publications

(48 citation statements)

References 29 publications

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“…Accordingly, it was previously reported in patients undergoing CABG that TEA is associated with a significantly smaller release of troponin T 24 hours after intensive care admission compared with that in patients not receiving TEA. 12 On the other hand, a recent meta-analysis including 1178 patients found that although TEA is associated with shorter time until tracheal intubation and decreased pulmonary complications and cardiac arrhythmias, no effect on mortality or rates of myocardial infarction could be found. 30 However, most of the studies included in this meta-analysis were small (Յ50 treated patients), and because the pooled mortality rate of the study was low, the authors concluded that more larger-scale randomized controlled trials are required to fully assess the potential benefits of TEA for the reduction of myocardial infarction and mortality after CABG.…”

Section: Discussionmentioning

confidence: 98%

“…8,9 In patients with ischemic heart disease, TEA has been evaluated as an adjunctive treatment for refractory chest pain during stable and unstable angina pectoris 10,11 and for improving postsurgical recovery after CABG. [12][13][14] On the other hand, it remains unclear to what extent these apparently beneficial effects of TEA are mediated by changes in myocardial blood flow or whether they are merely the result of improved pain relief.…”

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confidence: 99%

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Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

et al. 2005

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Background-In patients with ischemic heart disease, high thoracic epidural analgesia (TEA) has been proposed to improve abnormalities of coronary function by inhibiting cardiac sympathetic tone. We evaluated the effect of TEA on myocardial blood flow in patients with ischemic heart disease. Methods and Results-Twenty male patients with multivessel ischemic heart disease were studied. An epidural catheter was inserted between the second and third thoracic vertebral interspace (Th2 to Th3). Analgesia was induced by epidural injection of bupivacaine 0.5%, and a sensory block from the sixth cervical (C6 to C7) to Th10 (Th8 to Th11) vertebral interspace was achieved. Myocardial blood flow was measured with dynamic 13 N-ammonia PET with and without TEA at rest, during pharmacological vasodilation with dipyridamole, and during sympathetic stimulation with the cold pressor test. Myocardial blood flow during dipyridamole increased similarly, regardless of TEA, in all regions except in myocardium subtended by collateral arteries in which blood flow increased more with than without TEA (PϽ0.05). Without TEA, myocardial blood flow during the cold pressor test remained unchanged compared with myocardial blood flow at rest. In contrast, with TEA, myocardial blood flow increased in all vascular territories. Coronary vascular resistance increased during the cold pressor test without TEA, whereas with TEA, coronary resistance decreased in myocardium subtended by nonstenotic and stenotic coronary vessels and remained unchanged in myocardium subtended by occluded vessels. Conclusions-In patients with multivessel ischemic heart disease, TEA partly normalizes the myocardial blood flow response to sympathetic stimulation.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

et al. 2005

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“…The results of this study showed that the HTEA could significantly narrow the LVEDd, increase the LVEF, and improve heart function in ICM patients, especially for those with severe ICM, those who were not suitable for PCI, and those with refractory heart failure awaiting a heart transplant. HTEA could delay ventricular remodeling in ICM patients by selectively blocking the cardiac sympathetic nerve, which could reduce the sympathetic activity in patients with heart failure, reduce the damage to the myocardium by catecholamines, expand the coronary artery (Loick et al, 1999), improve the ischemic myocardium oxygen supply, and balance and improve myocardial Table 2. Comparison of heart rate variability and QTV changes between the two groups before and after treatment.…”

Section: Discussionmentioning

confidence: 99%

Effects of high thoracic epidural anesthesia on ischemic cardiomyopathy cardiac function and autonomic neural function

et al. 2014

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ABSTRACT. We aimed at observing the effects of high thoracic epidural anesthesia (HTEA) on cardiac structure and function, heart rate variability (HRV), and QT interval variation (QTV) in ischemic cardiomyopathy (ICM) patients with chronic heart failure. We divided 30 ICM patients into HTEA (N = 16) and control (N = 14) groups.The control group was treated with medication, and the HTEA group was treated with HTEA and medication for 4 weeks. We measured the changes in the left-ventricular end-diastolic diameter (LVEDd) and left-ventricular ejection fraction (LVEF) before and after treatment by using echocardiography and examined changes in HRV and QTV using ambulatory electrocardiogram. HTEA significantly narrowed the LVEDd, improved LVEF, significantly increased the HRV, and significantly reduced the QTV in the ICM group compared to the control group. HTEA significantly narrowed the ventricular chamber diameter size of ICM patients, enhanced myocardial contractility, increased myocardial electrical stability, and improved the cardiac structure and function.

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“…It was also observed an improvement in ventricular contractility after ischemic episodes with morphine and fentanyl (28). Besides participating in the triggering of the cascade of ischemic preconditioning, opioids also seem to mediate the memory phase in some animal species and the opioid-induced cardioprotection appears to be modulated by the activation of cardiac receptors, independent of the action of these drugs on the central nervous system [40][41] . It has been proposed that opioid-induced cardioprotection is processed by the activation of ATP-dependent potassium channels, possibly in the mitochondrial membrane (29).…”

Section: Myocardial Protectionmentioning

confidence: 98%

Perioperative Organ Protection in Cardiac Surgery

Carmona¹,

Vane²,

Malbouisson³

2012

Perioperative Considerations in Cardiac Surgery

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High Thoracic Epidural Anesthesia, but Not Clonidine, Attenuates the Perioperative Stress Response Via Sympatholysis and Reduces the Release of Troponin T in Patients Undergoing Coronary Artery Bypass Grafting

Cited by 188 publications

References 29 publications

Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

Effects of high thoracic epidural anesthesia on ischemic cardiomyopathy cardiac function and autonomic neural function

Perioperative Organ Protection in Cardiac Surgery

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