[The hemodynamic effects during thoracic epidural anesthesia combined with general anesthesia in patients undergoing...

To investigate the hemodynamic effects between the two established anesthetic managements: thoracic epidural anesthesia combined with general anesthesia (TEA + GA) as well as total intravenous anesthesia (TIVA).

Forty-four patients undergoing major abdominal operation were randomized to TEA + GA (n = 22) group or TIVA (n = 22) group. After thoracic epidural catheterization, the anesthesia induction and endotracheal intubation was made and a standard anesthesia procedure was administered for both groups. In TEA + GA group, the patients received thoracic epidural anesthesia (TEA) with 0.25% bupivacaine (bolus 0.5 mg/kg firstly and then infused continuously with 0. 2 ml x kg(-1) x h(-1)). While in TIVA group, the patients received 0.9% saline via epidural catheter just with the same bolus volume and same infusion rate as in TEA + GA group. The parameters monitored were as follows: ECG, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), central venous pressure, cardiac index (CI), systemic vascular resistance (SVR), pulse oximetry and PetCO2. Blood gas analysis was made as needed. The observation time for both groups was 90 min.

After epidural infusion of bupicacaine (TEA + GA group) or saline (TIVA group), SAP, DAP, HR and SVR in TEA + GA group were statistically decreased in comparing with the baseline, and SAP, DAP, MAP and SVR were also decreased significantly when compared with those in TIVA group (P < or = 0.05). However, CI and SV in TEA + GA group changed little and showed no statistical differences in comparing with those in TIVA group.

This study gives evidences that TEA in combination with GA had no negative effects on cardiac functions. The decrease of blood pressure may possibly be caused by the reduction of systemic vascular resistance.