The Effect of Thoracic Extradural Analgesia on Pulmonary Gas Distribution, Functional Residual Capacity and Airway Closure

McCarthy, Graham

doi:10.1093/bja/48.3.243

Cited by 49 publications

(15 citation statements)

References 13 publications

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“…[19] In contrast, others have not found that TEA has any influence on spirometry or lung dynamics. [20] In our study, we found better spirometric values in patients who received TEA, probably due to better analgesia as demonstrated by lower VAS values both at rest and coughing. We also used low concentration (0.125%) of bupivacaine which is unlikely to produce motor paralysis.…”

Section: Discussionsupporting

confidence: 60%

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m² for off pump coronary artery bypass surgery

et al. 2010

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Perioperative Thoracic epidural analgesia (TEA) is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index >30 kg/m2 for elective OPCAB were randomized into two groups (n=30 each). Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO2/FiO2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

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Section: Discussionsupporting

confidence: 60%

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m² for off pump coronary artery bypass surgery

et al. 2010

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“…Mismatching of ventilation and perfusion in the lungs is accompanied by impairment of pulmonary gas exchange [3,4]. Epidural anaesthesia, on the other hand, does not appear to influence FRC or airway closure and has little effect on the ventilation/perfusion match (V A /Q ) [5,6]. However, epidural anaesthesia causes alterations of chest wall motion that may affect regional lung volume and ventilation [7,8].…”

mentioning

confidence: 99%

Lung aeration and pulmonary gas exchange during lumbar epidural anaesthesia and in the lithotomy position in elderly patients

et al. 1998

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SummaryWe investigated a total of 36 subjects with a mean (SD) age of 65 (13) years, during baseline conditions (supine, before any anaesthesia), and then during one of the following protocols: (1) lithotomy positioning (n ¼ 12), (2) epidural anaesthesia (n ¼ 12), (3) general anaesthesia in the supine position (n ¼ 12). Lung aeration, ventilation/perfusion matching, gas exchange and functional residual capacity were measured. Lung aeration was normal during baseline assessment with almost no regions with poor aeration and no substantial dependent densities. Shunt and perfusion of poorly ventilated regions were minor. Lithotomy positioning did not reduce functional residual capacity and did not affect aeration of the lung or ventilation/perfusion matching. Epidural anaesthesia, in general, had no effect on aeration, ventilation/perfusion matching or gas exchange, regardless of whether the patient was in the supine or lithotomy position. General anaesthesia, however, caused significant increases in poorly aerated lung regions and in dependent densities (interpreted as atelectasis). In conclusion, no or little impairment of lung aeration and ventilation/perfusion matching was caused by the lithotomy position and/or epidural anaesthesia, contrary to the effects seen during general anaesthesia. However, our findings also suggest that being overweight is a factor that may cause impairment of lung aeration.

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“…This is the first study in children examining the impact of a neuroaxial blockade on FRC. Only studies performed in adults are available to compare our findings on the effect of epidural anaesthesia on FRC [17][18][19][20][21]. While some of the adult studies found no effect of lumbar or thoracic epidural anaesthesia [18][19][20], others showed a decrease [21] or an increase in FRC [17].…”

Section: Discussionmentioning

confidence: 86%

The effect of caudal block on functional residual capacity and ventilation homogeneity in healthy children*

Ungern‐Sternberg¹,

Regli²,

Frei³

et al. 2006

Anaesthesia

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SummaryCaudal block results in a motor blockade that can reduce abdominal wall tension. This could interact with the balance between chest wall and lung recoil pressure and tension of the diaphragm, which determines the static resting volume of the lung. On this rationale, we hypothesised that caudal block causes an increase in functional residual capacity and ventilation distribution in anaesthetised children. Fifty-two healthy children (15-30 kg, 3-8 years of age) undergoing elective surgery with general anaesthesia and caudal block were studied and randomly allocated to two groups: caudal block or control. Following induction of anaesthesia, the first measurement was obtained in the supine position (baseline). All children were then turned to the left lateral position and patients in the caudal block group received a caudal block with bupivacaine. No intervention took place in the control group. After 15 min in the supine position, the second assessment was performed. Functional residual capacity and parameters of ventilation distribution were calculated by a blinded reviewer. Functional residual capacity was similar at baseline in both groups. In the caudal block group, the capacity increased significantly (p < 0.0001) following caudal block, while in the control group, it remained unchanged. In both groups, parameters of ventilation distribution were consistent with the changes in functional residual capacity. Caudal block resulted in a significant increase in functional residual capacity and improvement in ventilation homogeneity in comparison with the control group. This indicates that caudal block might have a beneficial effect on gas exchange in anaesthetised, spontaneously breathing preschool-aged children with healthy lungs. Various anaesthetic agents, airway instrumentations and ventilation strategies are used in infants and children undergoing anaesthesia. Each of these factors may affect functional residual capacity (FRC), which is one of the most important respiratory parameters of gas exchange. There is very little information available on the magnitude and the relative contribution of these different factors (e.g. neuroaxial blockade with local anaesthetics) on functional residual capacity in anaesthetised children [1][2][3][4].Muscle relaxation induced by caudal epidural anaesthesia with bupivacaine decreases abdominal muscle tone while sparing the muscles of the respiratory system (diaphragm, intercostal muscles). This could interact with the balance between chest wall and lung recoil pressure and tension of the diaphragm, which determines the static resting volume of the lung. This alteration of the equilibrium between the thoracal and abdominal compartments might affect the functional residual capacity and ventilation homogeneity of the lungs. This study

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The Effect of Thoracic Extradural Analgesia on Pulmonary Gas Distribution, Functional Residual Capacity and Airway Closure

Cited by 49 publications

References 13 publications

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m² for off pump coronary artery bypass surgery

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m² for off pump coronary artery bypass surgery

Lung aeration and pulmonary gas exchange during lumbar epidural anaesthesia and in the lithotomy position in elderly patients

The effect of caudal block on functional residual capacity and ventilation homogeneity in healthy children*

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The Effect of Thoracic Extradural Analgesia on Pulmonary Gas Distribution, Functional Residual Capacity and Airway Closure

Cited by 49 publications

References 13 publications

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

Lung aeration and pulmonary gas exchange during lumbar epidural anaesthesia and in the lithotomy position in elderly patients

The effect of caudal block on functional residual capacity and ventilation homogeneity in healthy children*

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Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m² for off pump coronary artery bypass surgery

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m² for off pump coronary artery bypass surgery