Thoracic Epidural Anesthesia Improves Global and Regional Left Ventricular Function During Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease

Abstract

The aim of the present investigation was to study the effects of high thoracic epidural anesthesia (TEA), including the cardiac sympathetic segments, on ischemic ST-segment changes and left ventricular global and regional wall motion abnormalities. Ten patients with a two- or three-vessel coronary artery disease, all treated with the beta-adrenergic blocker metoprolol because of severe stable angina pectoris, performed two identical exercise stress tests, the first without TEA (control exercise) and the second with TEA (TEA exercise). Before each stress test, intravenous metoprolol was given to achieve maximal or near maximal beta-adrenoceptor blockade. Systolic and diastolic arterial pressures (radial artery cannula), heart rate, and rate-pressure product, as well as global and regional ejection fractions, using equilibrium radionuclide angiography in the left anterior oblique projection, were measured at rest and during maximal exercise. ST-segment analysis (V3 or V5) was performed, and the regional wall motion score was calculated at control exercise and TEA exercise. Intravenous metoprolol or intravenous metoprolol plus TEA at rest did not cause any significant changes of any of the variables. During TEA exercise, systolic arterial pressure, diastolic arterial pressure, and rate-pressure product, but not heart rate, were significantly lower compared to control exercise. The global and anterolateral ejection fractions were significantly higher (52.8% versus 46.5% and 53.2% versus 46.0%, respectively, P less than 0.05), and the regional wall motion score was significantly lower (8.8 versus 11.8, P less than 0.01) during TEA exercise than during control exercise. ST-segment depression was significantly lower during TEA exercise (-1.03 versus -1.84 mV, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Anaesthesia for coronary artery bypass surgery supplemented with subarachnoid bupivacaine and morphine: a report of 18 cases

“…2~ Both blockade of nociceptive afferent nerves and relief of myocardial ischaemia may contribute to the relief of angina, z~ In addition, left ventricular global and regional wall motion abnormalities and ST-segment changes are improved. 23 A recent study has shown benefits of thoracic epidural anaesthesia/analgesia for CABG surgery. 9,1~ These included better haemodynamic stability, earlier awakening and extubation, better pulmonary variables and less catecholamine response.…”

Ropivacaína em bloqueio peridural torácico para cirurgia plástica

“…These are beneficial effects because they decrease cardiovascular excitation and reduce myocardial oxygen consumption by controlling systolic blood pressure and heart rate. There are multiple clinical implications, such as decrease in cardiovascular excitatory responses to tracheal intubation 18 , perioperative myocardial ischemia control in cardiac diseases 19 and, in our case, less bleeding in plastic surgeries with hypotensive anesthesia. Tachycardia is a major factor for increasing cardiac output and bleeding during surgery.…”

“…Estes efeitos são benéficos no sentido de diminuir a excitação cardiovascular, reduzindo o consumo de oxigê-nio pelo miocárdio em função do controle de pressão arterial sistólica e da freqüência cardíaca. As implicações clínicas são múltiplas, compreendendo a redução das respostas excitatórias cardiovasculares à intubação traqueal 18 , o controle da isquemia miocárdica perioperatória em coronariopatas 19 e, no nosso caso, a obtenção de menor sangramento em cirurgia plástica com anestesia hipotensiva. A taquicardia é um dos fatores que mais contribuem para o aumento do débito cardíaco e o sangramento durante a cirurgia.…”

Thoracic epidural blockade preserves left ventricular early diastolic filling assessed by transesophageal echocardiography

“…However, this observation remains controversial. In other investigations, TEA has been found to improve LV contractility [13] or to have no effect on it [141 .…”