The Practice of Thoracic Epidural Analgesia: A Survey of Academic Medical Centers in the United States

Minzter, Beth H.; Johnson, Raymond F.; Grimm, Barbara J

doi:10.1213/00000539-200208000-00044

Cited by 18 publications

(5 citation statements)

References 6 publications

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“…(Moore & Batra, 1981) A survey of academic medical centers in the United States found that 83% of the respondents indicated they use a test dose, whereas 6% do not. (Minzter et al, 2002) …”

Section: Epidural Test Dosementioning

confidence: 99%

Epidural Analgesia for Perioperative Upper Abdominal Surgery

Siriussawakul¹,

Suwanpratheep²

2012

Epidural Analgesia - Current Views and Approaches

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“…(Moore & Batra, 1981) A survey of academic medical centers in the United States found that 83% of the respondents indicated they use a test dose, whereas 6% do not. (Minzter et al, 2002) …”

Section: Epidural Test Dosementioning

confidence: 99%

Epidural Analgesia for Perioperative Upper Abdominal Surgery

Siriussawakul¹,

Suwanpratheep²

2012

Epidural Analgesia - Current Views and Approaches

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“…The most effective technique for acute pain management after thoracic surgery is thoracic epidural analgesia (TEA). Several surveys have demonstrated that more than 50% (54%–85.6%) of thoracic anesthesiologists use TEA as the first-line treatment option for pain management [ 27 , 28 , 29 , 30 , 31 , 32 ]. However, TEA induces vasodilation below the level of the block, commonly resulting in hypotension, which may be exacerbated and have negative consequences for patients with higher risk of SAM and LVOTO [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Systolic Anterior Motion in Robotic Thoracic Surgery as the Cause of Unexplained Hemodynamic Shock: From a Case Report to Recommendations

Monaco

D’Amico

Barucco

et al. 2022

JCM

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Robotic major lung resection for lung cancer carries a risk for intraoperative hemodynamic instability. Systolic anterior motion (SAM) of the mitral valve is a rare and often misrecognized cause of intraoperative hemodynamic instability. If not promptly recognized, SAM leads to a complicated perioperative course. Here, we report for the first time a case of a patient with SAM with a severe degree of left ventricular outflow obstruction (LVOTO) undergoing robotic lung lobectomy and its challenging intraoperative management. A 70-year-old man undergoing robotic left upper lobectomy developed immediately after the induction of general anesthesia hemodynamic instability due to SAM-related LVOTO. The diagnosis was possible, thanks to the use of transesophageal echocardiography (TEE). The treatment strategies applied were preload optimization without fluid overload, ultra-short-acting beta-blockers, and vasopressors. Peripheral nerve blockades were preferred over epidural analgesia to avoid vasodilatation. The patient reported a good quality of recovery and no pain the day after surgery. The management of patients with higher risk of SAM and LVOTO development during robotic thoracic surgery requires a dedicated and skilled team together with high-impact treatment strategies driven by TEE. Since current guidelines do not recommend the use of TEE, even for patients with higher cardiac risk undergoing noncardiac surgery, the present case report may stimulate interest in future recommendations.

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“…Although most anesthesiologists agree that a thoracic “test dose” is important, no evidence-based standard recipe for this procedure exists. 59,60 Prevalent practice has been to adopt one of the commonly used lumbar regimens. However, lumbar dosing is guided by experience from spinal anesthesia, anticipating that a positive test result in a sitting patient would develop no more than a traditional “saddle block.” In contrast, thoracic dosing has no equivalent to spinal anesthesia for guidance.…”

Section: Analgesic Agentsmentioning

confidence: 99%

Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes

Bottiger

Esper

Stafford‐Smith

2013

Semin Cardiothorac Vasc Anesth

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Pain after thoracic surgery can be severe and, in the acute phase, contribute to perioperative morbidity and mortality. Unfortunately, patients also incur a significant risk of chronic pain. Although there are guidelines for postoperative pain management in these patients, there is no widespread surgical or anesthetic "best practice." Here, we review the recent literature on techniques specific to perioperative pain control for thoracic patients, including medical management, neuraxial blockade, and other regional techniques, and suggest an algorithm for developing a multimodal pain management strategy.

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The Practice of Thoracic Epidural Analgesia: A Survey of Academic Medical Centers in the United States

Cited by 18 publications

References 6 publications

Epidural Analgesia for Perioperative Upper Abdominal Surgery

Epidural Analgesia for Perioperative Upper Abdominal Surgery

Mitral Valve Systolic Anterior Motion in Robotic Thoracic Surgery as the Cause of Unexplained Hemodynamic Shock: From a Case Report to Recommendations

Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes

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