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Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function With Maintained Ventricular-Pulmonary
Jeroen Wink1, Rob B P de Wilde2, Patrick F Wouters2
1From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.). j.wink@lumc.nl.
Thoracic epidural anesthesia impairs right ventricular contractility but preserves its response to increased afterload. Ventricular-pulmonary coupling decreases with higher afterload, unaffected by this anesthesia.
Area of Science:
- Cardiology
- Anesthesiology
- Pulmonary Medicine
Background:
- Thoracic epidural anesthesia (TEA) may impact right ventricular (RV) function and its interaction with afterload.
- Understanding these effects is crucial for patients undergoing thoracic surgery.
Purpose of the Study:
- To investigate the effects of TEA on RV function.
- To assess the impact of TEA on the coupling between RV function and RV afterload.
Main Methods:
- Ten patients undergoing lung resection were studied.
- RV function and response to pulmonary artery clamping (increased afterload) were measured before and after TEA using pressure-conductance catheters.
Main Results:
- TEA significantly decreased RV contractility and systolic function.
- Effective arterial elastance also decreased, maintaining ventricular-pulmonary coupling.
- Pulmonary artery clamping increased afterload, enhancing RV contractility but decreasing coupling; these responses were similar before and after TEA.
Conclusions:
- TEA impairs RV contractility but does not abolish the RV's inotropic response to increased afterload.
- Ventricular-pulmonary coupling is reduced by increased afterload, independent of TEA induction.
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