Pulmonary Reactivity to Methacholine during β-adrenergic Blockade

Tobias, Joseph D.; Sauder, Russell A.; Hirshman, Carol A.

doi:10.1097/00000542-199007000-00019

Cited by 12 publications

(6 citation statements)

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“…β2-adrenegic receptors are stimulated not by direct sympathetic innervation, but by circulating catecholamines. Therefore, blockade of β2-adrenergic receptors by nonspecific β-adrenergic receptor blockers can lead to increased airway resistance and acute bronchospasm [64][65][66][67]. In contrast, the effect of the direct blockade of the sympathetic innervation seems to be negligible.…”

Section: Effects Of Thoracic Epidural Anesthesia In Patients With Bromentioning

confidence: 99%

Epidural anesthesia and pulmonary function

Groeben¹

2006

J Anesth

108

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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.

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Section: Effects Of Thoracic Epidural Anesthesia In Patients With Bromentioning

confidence: 99%

Epidural anesthesia and pulmonary function

Groeben¹

2006

J Anesth

108

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“…Beta-adrenergic blockade administered orally, intravenously, or by inhalation increases BHR during a challenge or aggravates clinical symptoms (21)(22)(23), but attempts to decrease cholinergic activity, such as truncal vagotomy, do not always inhibit bronchoconstriction in asthma patients (24). There have been some reports that thoracic sympathectomy can affect the airway reactivity (5,7,8).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Thoracosopic Thoracic Sympathetomy on Pulmonary Function and Bronchial Hyperresponsiveness

Kim¹,

Lee²,

Lee³

et al. 2009

Journal of Asthma

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“…The replacement of propranolol with more cardioselective p-blockers can reduce, but not eliminate, the risk. Other recent observations in an animal model (22) and in cardiac patients with airway obstruction (23) provide the anesthesiologist with additional perspective on the acute use of intravenous P-block. However, often antihypertensive treatment requires larger and noncardioselective doses which do have adverse effects on pulmonary function (21).…”

Section: Pharmacotherapy Of Airway Reactivity S Ympat Homime T Icsmentioning

confidence: 98%

Bronchial Hyperresponsiveness and Anesthesia

Gal

1994

Anesthesia & Analgesia

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Pulmonary Reactivity to Methacholine during β-adrenergic Blockade

Cited by 12 publications

References 0 publications

Epidural anesthesia and pulmonary function

Epidural anesthesia and pulmonary function

The Effect of Thoracosopic Thoracic Sympathetomy on Pulmonary Function and Bronchial Hyperresponsiveness

Bronchial Hyperresponsiveness and Anesthesia

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