Cardiovascular reflexes during anesthesia induction and tracheal intubation in elderly patients: the influence of thoracic epidural anesthesia

Journal of Clinical Anesthesia
M LickerC E Klopfenstein

Abstract

To determine whether thoracic epidural anesthesia performed prior to general anesthesia provides hemodynamic protection from the stress of laryngoscopy and tracheal intubation; to access the autonomic reflex response to epidural anesthesia, general anesthesia, and airway stimulation. Randomized unblind, controlled study. 20 elderly (over 60) patients scheduled for colonic or gastric surgery at a university medical center. All patients (n = 10, in each group) underwent a standardized anesthesia induction sequence that included fentanyl 2 micrograms/kg, thiopental sodium 3 to 5 mg/kg (up to loss of eyelid reflex), and vecuronium 0.1 mg/kg followed by laryngoscopy and tracheal intubation. Before general anesthesia, thoracic epidural anesthesia was performed with plain 1% lidocaine in the epidural group. Preoperatively, baroreflex function was assessed by the Valsalva maneuver and the cough test. Spectral analysis of heart rate (HR) variability was performed before as well as during anesthesia. There were no differences between the two groups in basal hemodynamics autonomic reflex status. Thoracic epidural anesthesia (median upper level at T2, median lower level at L2) was associated with stable hemodynamics, preservation of barore...Continue Reading

References

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Citations

Mar 24, 2000·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·T KasabaM Takasaki
Jun 1, 2000·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·M LickerD R Morel
Sep 27, 2001·Anesthesiology Clinics of North America·E Cohen
Nov 16, 2013·Anesthesiology Research and Practice·George VretzakisMetaxia Bareka
Jun 15, 2007·European Journal of Anaesthesiology·C PaisansathanF T Charbel
Jan 12, 2001·Anaesthesia and Intensive Care·B T Veering, M J Cousins
Apr 26, 2002·Anesthesia and Analgesia·Luis CasatiMargarita M Puig
Oct 16, 2010·Journal of Cardiothoracic and Vascular Anesthesia·Marina SimeoforidouNikolaos Tsilimingas

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