Postoperative Pulmonary Complications Epidural Analgesia Using Bupivacaine and Opioids Versus Parenteral Opioids

Jayr, Christian; Thomas, H.; Rey, Annie; Farhat, F.; Lasser, P; Bourgain, Jean-Louis

doi:10.1097/00000542-199304000-00009

Cited by 207 publications

(65 citation statements)

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“…An effective epidural block is thought to attenuate the neuro-humoral stress response to surgery, potentially improving postoperative cardio-respiratory function and reducing complications [4]. Initial trials and meta-analyses seemed to support this theory [5]. A 1997 systematic review examining the effects of neuraxial blockade on outcome suggested reduced mortality and (serious) morbidity.…”

mentioning

confidence: 99%

Epidural analgesia: first do no harm

Low¹,

Johnston

Morris³

2007

Anaesthesia

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mentioning

confidence: 99%

Epidural analgesia: first do no harm

Low¹,

Johnston

Morris³

2007

Anaesthesia

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“…More recent large clinical trials (not blinded) found few differences in outcomes between those receiving and not receiving epidural analgesia, with the exceptions that: 1) respiratory failure was less frequent for some types of operations, and 2) postoperative pain control was improved by epidural analgesia. 70 In a blinded trial, Jayr et al 71 demonstrated that epidural techniques provide superior postoperative analgesia, but do not affect the frequency of postoperative pulmonary complications. In another blinded trial, Norris et al 72 was unable to demonstrate a major outcome benefit of an epidural anesthetic technique, other than slightly shorter times to tracheal extubation.…”

Section: Intraoperative and Postoperative Analgesiamentioning

confidence: 99%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

145

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Purpose: This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure.Source: A MEDLINE-based English-language literature search was undertaken for the period 1966-2006, and an EMBASE search covered the overlapping period 1988-2006. Selected articles were limited to those applying to elderly subjects/patients. Principal findings:Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population. Conclusion:Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery. Objectif

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“…Systematic review supports use of either epidural or nerve block analgesia following thoracotomy [83]. At present, no consensus has been reached regarding systemic opioid administration or drugs for use in the epidural space, however there is no doubt that appropriate postoperative analgesia increases patient quality of life [84,85].…”

Section: Postoperative Managementmentioning

confidence: 99%

The Perioperative Management of Asthma

Applegate

2013

J Allergy Ther

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Anesthesiologists encounter asthmatic patients routinely. This common disease frequently complicates the perioperative care of those patients who live with it and can occasionally lead to life-threatening complications. This review takes the anesthesiologist's perspective to discuss asthma and how asthmatic patients can be safely guided through an anesthetic. We will discuss frequently used asthma medications, pre-operative disease optimization, management of intra-operative bronchospasm, and post-operative considerations for asthmatic patients. Anesthesiologists can make a positive difference in the outcomes of these patients with proper preoperative evaluation using a stepwise approach to disease management and by minimizing bronchoconstriction and effectively treating it when it develops.

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Postoperative Pulmonary Complications Epidural Analgesia Using Bupivacaine and Opioids Versus Parenteral Opioids

Cited by 207 publications

References 0 publications

Epidural analgesia: first do no harm

Epidural analgesia: first do no harm

Review article: Age related alterations in respiratory function — anesthetic considerations

The Perioperative Management of Asthma

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