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Clinical Trial
. 2005 Jun;100(6):1561-1569.
doi: 10.1213/01.ANE.0000154963.29271.36.

The effect of high thoracic epidural anesthesia on systolic and diastolic left ventricular function in patients with coronary artery disease

Christoph Schmidt  1 , Frank Hinder, Hugo Van Aken, Gregor Theilmeier, Christian Bruch, Stefan P Wirtz, Hartmut Bürkle, Tim Gühs, Markus Rothenburger, Elmar Berendes
Affiliations
Clinical Trial

The effect of high thoracic epidural anesthesia on systolic and diastolic left ventricular function in patients with coronary artery disease

Christoph Schmidt et al. Anesth Analg. 2005 Jun.

Abstract

In patients with coronary artery disease, vasoconstriction is induced through activation of the sympathetic nervous system. Both alpha1- and alpha2-adrenergic epicardial and microvascular constriction are potent initiators of myocardial ischemia. Attenuation of ischemia has been observed when sympathetic nervous system activity is inhibited by high thoracic epidural anesthesia (HTEA). However, it is still a matter of controversy whether establishing HTEA may correspondingly translate into an improvement of left ventricular (LV) function. To clarify this issue, LV function was quantified serially before and after HTEA using a new combined systolic/diastolic variable of global LV function (myocardial performance index [MPI]) and additional variables that more specifically address systolic (e.g., fractional area change) or diastolic function (e.g., intraventricular flow propagation velocity [Vp]). High thoracic epidural catheters were inserted in 37 patients scheduled for coronary artery surgery, and HTEA was administered in the awake patients. Echocardiographic and hemodynamic measures were recorded before and after institution of HTEA. HTEA induced a significant improvement in diastolic LV function (e.g., Vp changed from 45.1 +/- 16.1 to 53.8 +/- 18.8 cm/s; P < 0.001), whereas indices of systolic function did not change. The change in the diastolic characteristics caused the MPI to improve from 0.51 +/- 0.13 to 0.35 +/- 0.13 (P < 0.001). We conclude that an improvement in cardiac function was due to improved diastolic characteristics.

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References

    1. Olausson K, Magnusdottir H, Lurje L, et al. Anti-ischemic and anti-anginal effects of thoracic epidural anesthesia versus those of conventional therapy in the treatment of severe refractory unstable angina pectoris. Circulation 1997;96:2178–82.
    1. Blomberg S, Emanuelsson H, Ricksten SE. Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris. Anesth Analg 1989;69:558–62.
    1. Nabel E, Ganz P, Gordon JB, et al. Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test. Circulation 1988;77:43–52.
    1. Blomberg S, Emanuelsson H, Kvist H, et al. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 1990;73:840–7.
    1. Saada M, Catoire P, Bonnet F, et al. Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. Anesth Analg 1992;75:329–35.

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