Effect of increasing age on the haemodynamic response to thoracic epidural anaesthesia

Wink, Jeroen; Veering, Bernadette; Aarts, Leon; Wouters, Patrick

doi:10.1097/eja.0000000000000125

Cited by 11 publications

(4 citation statements)

References 29 publications

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“…Tramadol may exert these effects by reducing the stress response to surgery and pain ( 14 , 15 ). Perioperative trauma and pain cause stress reactions, as well as the release of proinflammatory cytokines, including C-reactive protein, tumor necrosis factor α, interleukin (IL)-1, IL-6 and IL-8.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, IL-6 is a marker of endothelial dysfunction, and elevated levels of this cytokine are associated with a low FMD in patients suffering from myocardial infarction ( 29 ). Thoracic epidural analgesia can reduce the stress responses to surgery and pain by blocking the neuroendocrine pathway ( 14 ). Micromolar concentrations of morphine inhibit the lipopolysaccharide-induced synthesis of IL-6 ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

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Analgesic therapy improves arterial endothelial function following non‑cardiovascular surgery: A randomized, placebo‑controlled trial

Yang²,

Ran

et al. 2017

Exp Ther Med

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Pain subsequent to non-cardiac surgery may affect the endothelial function, which in turn contributes to myocardial injury (MI). The present study examined whether effective pain control is able to improve the postoperative endothelial function. Patients (n=160) undergoing laparoscopic cholecystectomy were randomly assigned into two groups, treated with tramadol analgesic or saline (placebo) following surgery. On preoperative day 1 (baseline) and postoperatively at 2 h, 1 day and 5 days, pain was assessed on a visual analogue scale (VAS), and B-mode ultrasound was used to measure brachial endothelium-dependent flow-mediated dilation (FMD) and nitroglycerin-induced dilation. At 2 h postoperatively, the FMD in the two groups was significantly lower compared with that at the other three time points (P≤0.005), while VAS was significantly higher (P<0.05). Patients in the tramadol group presented significantly reduced VAS values in comparison with those in the placebo group at 2 h and 1 day postoperatively (P=0.013 and 0.031, respectively), as well as significantly higher FMD at 2 h (6.7±1.5 vs. 6.0±1.7%; P=0.001) and 1 day postoperatively (7.3±1.3 vs. 6.9±1.4%; P=0.03). A VAS score of <5 was independently associated with postoperative FMD of ≥7 (odds ratio, 2.5; 95% confidence interval, 1.0–6.0; P=0.047). Backward multivariate linear regression also demonstrated that FMD was independently correlated with age and VAS score (B=−1.403, P=0.011; B=−0.579, P=0.003). The response to nitroglycerin-induced dilation remained stable in all patients at baseline and at all postoperative time points. In conclusion, analgesic treatment may improve the arterial endothelial function following non-cardiac surgery, which may help prevent postoperative MI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analgesic therapy improves arterial endothelial function following non‑cardiovascular surgery: A randomized, placebo‑controlled trial

Yang²,

Ran

et al. 2017

Exp Ther Med

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“…В целом результаты этих исследований свидетельствуют, что эпидуральная блокада ухудшает систолическую функцию правого желудочка, в частности его геометрическую адаптацию к повышенному давлению в малом круге кровообращения. Результаты клинических публикаций носят противоречивый характер; так, обсервационное исследование, проведенное на 35 больных, выявило улучшение функции правого желудочка после проведения эпидуральной анестезии [27]. Однако данное исследование осуществляли на пациентах, находящихся в сознании, поэтому невозможно экстраполировать его результаты на больных после стернотомии в условиях комбинированной анестезии.…”

Section: влияние эпидуральной анестезии на миокардunclassified

The use of epidural anesthesia in coronary surgery: pro and contra. Review

Volkov

Paromov

Еремеев³

et al. 2020

Annals of Critical Care

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The cardiovascular diseases have top-rated place amongst causes of death all around the world. The leading cardiovascular pathology is coronary artery disease; its course is dependent on severity of atherosclerotic lesion of coronary vessels. Coronary artery bypass grafting (CABG) is one from the most often performed medical techniques of coronary revascularization but has a high risk of perioperative respiratory complications, myocardial infarction, dysrhythmias, kidney dysfunction and other problems. High thoracic epidural anesthesia (HTEA) and analgesia provides sympathetic nerve block of cardiac dermatomes, decreases perioperative stress and pain after CABG, and has a protective role regarding cardiac and respiratory functions. These effects of HTEA are confirmed by a number of studies and systematic reviews. Apart from evident benefits of HTEA, there are restrictions for its use in cardiac surgery associated with increased risk of epidural hematoma followed by neurological consequences. In our review, we describe physiological effects and clinical aspects of using HTEA in coronary surgery.

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“…1). This reduces the cardiac chronotropic and inotropic state, the occurrence and magnitude of which seem to vary between individuals and conditions (Wink et al, 2014). In heart failure, an increased sympathetic tone is considered to underlie a chain of effects with detrimental impact on prognosis (Florea and Cohn, 2014;Cohn et al, 1984;Anand et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation

Wink

Delft

Notenboom

et al. 2020

Autonomic Neuroscience

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Background: Cardiac sympathetic blockade is a therapeutic approach for arrhythmias and heart failure and may be a beneficial effect of high thoracic epidural anesthesia. These treatments require detailed knowledge of the spatial location and distribution of cardiac autonomic nerves, however, there are controversies on this subject in humans. Objective: To provide a systematic overview of current knowledge on human anatomy of the cardiac autonomic nervous system. Results: In contrast to the often claimed assumption that human preganglionic sympathetic cardiac neurons originate mainly from thoracic spinal segments T1-T4 or T5, there is ample evidence indicating involvement of cervical spinal segment C8 and thoracic spinal segments below T5. Whether cervical ganglia besides the stellate ganglion play a role in transmission of cardiac sympathetic signals is unclear. Similarly, there is debate on the origin of cardiac nerves from different thoracic ganglia. Most human studies report thoracic cardiac nerves emerging from the first to fourth thoracic paravertebral ganglia; others report contributions from the fifth, sixth and even the seventh thoracic ganglia. There is no agreement on the precise composition of nerve plexuses at the cardiac level. After years of debate, it is generally accepted that the vagal nerve contributes to ventricular innervation. Vagal distribution appears higher in atria, whereas adrenergic fibers exceed the number of vagal fibers in the ventricles. Conclusion: Anatomy of the human cardiac autonomic nervous system is highly variable and likely extends beyond generally assumed boundaries. This information is relevant for thoracic epidural anesthesia and procedures targeting neuronal modulation of cardiac sympathetic innervation.

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Effect of increasing age on the haemodynamic response to thoracic epidural anaesthesia

Abstract: EudraCT 2009-010594-20.

Cited by 11 publications

References 29 publications

Analgesic therapy improves arterial endothelial function following non‑cardiovascular surgery: A randomized, placebo‑controlled trial

Analgesic therapy improves arterial endothelial function following non‑cardiovascular surgery: A randomized, placebo‑controlled trial

The use of epidural anesthesia in coronary surgery: pro and contra. Review

Human adult cardiac autonomic innervation: Controversies in anatomical knowledge and relevance for cardiac neuromodulation

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