Epidural anesthesia and pulmonary function

Abstract

The epidural administration of local anesthetics can provide anesthesia without the need for respiratory support or mechanical ventilation. Nevertheless, because of the additional effects of epidural anesthesia on motor function and sympathetic innervation, epidural anesthesia does affect lung function. These effects, i.e., a reduction in vital capacity (VC) and forced expiratory volume in 1 s (FEV(1.0)), are negligible under lumbar and low thoracic epidural anesthesia. Going higher up the vertebral column, these effects can increase up to 20% or 30% of baseline. However, compared with postoperative lung function following abdominal or thoracic surgery without epidural anesthesia, these effects are so small that the beneficial effects still lead to an improvement in postoperative lung function. These results can be explained by an improvement in pain therapy and diaphragmatic function, and by early extubation. In chronic obstructive pulmonary disease (COPD) patients, the use of thoracic epidural anesthesia has raised concerns about respiratory insufficiency due to motor blockade, and the risk of bronchial constriction due to sympathetic blockade. However, even in patients with severe asthma, thoracic epidural anesthesia leads to a decrease of about 10% in VC and FEV(1.0) and no increase in bronchial reactivity. Overall, epidural administration of local anesthetics not only provides excellent anesthesia and analgesia but also improves postoperative outcome and reduces postoperative pulmonary complications compared with anesthesia and analgesia without epidural anesthesia.

Resection of Bullae Under Thoracic Epidural Anesthesia

“…Yine TEA ile ilişkili sempatik blokaj bronşial tonus ve hava yolları hiperreaktivitesi yapabilir. Ayrıca özellikle şid-detli amfizemli hastalarda hiperkapniyi indükler (13) . Ancak, yine de kontrollü ve ehil ellerde yapıldığı sü-rece daha güvenli ve tercih edilen bir yöntem olarak kullanılabilir.…”

Acute Postoperative Pain Control Following Thoracic Surgery

“…Following thoracic surgery, the respiratory benefi ts of TEA (improved dynamic analgesia, decreased splinting, etc. ), outweigh the negatives such that function is enhanced compared to that with systemic opioid analgesia ( 7 ). Even in patients with severe COPD, concerns regarding TEA-induced impairment of respiratory muscle strength are unwarranted when using conventional, dilute solutions.…”

Ultrasound guided chronic pain interventions (Part II)

“…Accurate determination of the level is essential for the application to be effective and have less side effects. [16] Mainly two anatomical landmarks are used for level determination at cervicothoracic region; these are spinous process of thoracic 7 th vertebra that passes under lower tip of scapula and C7 spinous process that is also called vertebra prominence. [17] However, level determination using these superficial landmarks may not always be accurate.…”