Time Course of the Effects of Cervical Epidural Anesthesia on Pulmonary Function

Stevens, Rosemary; Frey, Kere; Sheikh, Taqdees; Kao, Tzu‐Cheg; Mikat-Stevens, Marianne; Quiroga, Mauricio Morales

doi:10.1097/00115550-199823010-00006

Cited by 39 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…61 While such respiratory muscle dysfunction associated with both epidural and spinal anesthesia may compound to lung collapse in at-risk conditions, 25 this risk does not appear to be clinically relevant in patients without preexisting lung disease and might not surpass the benefits of avoiding general anesthesia in patients at high respiratory risk. 25,62…”

Section: Clinical Risk Factors For Perioperative Atelectasismentioning

confidence: 99%

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

et al. 2021

View full text Add to dashboard Cite

The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

show abstract

Section: Clinical Risk Factors For Perioperative Atelectasismentioning

confidence: 99%

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Most studies observe that CEA decreases tidal volume (TV), forced vital capacity (FVC), forced expiratory volume in the 1st second (FEV1) and vital capacity (VC). 18 56 Although Stevens and colleagues 18 did not find a decrease in maximum inspiratory pressure (MIP), it is most likely that MIP decreases-indicative of diaphragmatic weakness. 56 The parameters of Sa O2 ; Pa O2 also decrease, along with an increase in Pa CO2 .…”

Section: Systemic Effects As a Results Of Cervical Blockadementioning

confidence: 99%

“…Three reports used epidural nerve stimulation to identify and introduce the catheter. 5 12 14 Complications Dural punctures were reported in three reports [(n=1/50), 10 (n=2/ 394), 25 and (6.7% in group 2) 74 ]; respiratory difficulties to complete paralysis were reported in four reports [(n=1/7), 15 (n=1/15), 18 (n=3/394), 25 and (n=1) 28 ]; neurological complications were reported in four reports [( paraesthesia of the arm), 7 (right hemiparesis and Babinski sign), 11 (crus spasm and burning arm pain), 15 and (seizure) 26 ]; technical failures were reported in four reports [(n=1), 9 (n=1/3), 26 (n=1/50), 35 and (20% blocks at C4-5 were reported 57 ]; and serious haemodynamic and cardiac complications were reported in five reports. 22 25 31 33 46 There were no deaths reported; however, significant long-term morbidity and cardiac arrest were reported.…”

Section: Technical Considerationsmentioning

confidence: 99%

Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations

Shanthanna

Mendis

Goel

2016

British Journal of Anaesthesia

View full text Add to dashboard Cite

Cervical epidural analgesia (CEA) is an analgesic technique, potentially useful for surgeries involving the upper body. Despite the inherent technical risks and systemic changes, it has been used for various surgeries. There have been no previously published systematic reviews aimed at assessing its clinical utility. This systematic review was performed to explore the perioperative benefits of CEA. The review was also aimed at identifying the rationale of its use, reported surgical indications and the method of use. We performed a literature search involving PubMed and Embase databases, to identify studies using CEA for surgical indications. Out of 467 potentially relevant articles, 73 articles were selected. Two independent investigators extracted data involving 5 randomized controlled trials, 17 observational comparative trials, and 51 case reports (series). The outcomes studied in most comparative studies were on effects of local anaesthetics and other agents, systemic effects, and feasibility of CEA. In one randomized controlled study, CEA was observed to decrease the resting pain scores after pharyngo-laryngeal surgeries. In a retrospective study, CEA was shown to decrease the cancer recurrence after pharyngeal-hypopharyngeal surgeries. The limited evidence, small studies, and the chosen outcomes do not allow for any specific recommendations based on the relative benefit or harm of CEA. Considering the potential for significant harm, in the face of better alternatives, its use must have a strong rationale mostly supported by unique patient and surgical demands. Future studies must aim to assess analgesic comparator effectiveness for clinically relevant outcomes.

show abstract

“…With phrenic nerve innervation located at the C3 spinal level, any involvement of this area of the spinal cord can lead to respiratory compromise. A case study of patients undergoing cervical epidural spinal injection at the C7-T1 interspace showed that cervical epidural anesthesia leads to a measurable reduction in pulmonary functions consistent with the spread of analgesia to the C3 dermatome (23). While it has been shown that once analgesia reaches the C3 dermatome, there is significant change in forced expiratory volume in the first second of expiration (FEV1) and forced vital capacity (FVC), no outcomes of complete pulmonary arrest have been reported.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Arrest Following Cervical Epidural Injection

Nazari

2012

Pain Phys

View full text Add to dashboard Cite

Epidural steroid injection is a common treatment for the management of pain in a wide variety of patients. It is generally well tolerated and perceived to have few side effects, with a low risk of serious complications. Only a handful of reports exist that describe life-threatening complications such as subdural hematoma, respiratory depression, vasovagal response, and pneumocephalus. This is a case report of a 67-year-old woman with a relatively unremarkable past medical history, other than rheumatoid arthritis, osteoarthritis, and hypertension, who suffered from chronic neck pain treated with cervical epidural steroid injection at the C6-C7 level. She went into immediate cardiopulmonary arrest following the injection. She was brought to the emergency department by ambulance and resuscitated, and was found to have pneumocephalus. Ultimately, she made a relatively full recovery over the following weeks. Cardiopulmonary arrest is a rare but potentially deadly side effect of epidural steroid injection. To the best of our knowledge, this is the first report of such an arrest following a steroid injection in the cervical spinal region. There are several possible mechanisms for the immediate arrest, including cardioacceleratory center blockade, severe vasovagal response, iatrogenic pneumocephalus, and involvement of the phrenic nerve followed by apnea. Our conclusion in this case is that the most likely scenario was injection of the C6-C7 level led to a blockade of the cardiac accelerator fibers located just below in the T1-T4 spinal level, causing a sympathetic blockade and profound bradycardia, leading to cardiopulmonary arrest. Key words: Cardiopulmonary arrest, cervical epidural steroid injection, pneumocephalus, cardiac accelerator, vasovagal, chronic neck pain.

show abstract

Time Course of the Effects of Cervical Epidural Anesthesia on Pulmonary Function

Cited by 39 publications

References 0 publications

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations

Cardiopulmonary Arrest Following Cervical Epidural Injection

Contact Info

Product

Resources

About