[Endotracheal intubation in thoracic catheter peridural anesthesia]

After standard preparation, the catheter is preferably inserted in a sitting position. A test dose of 4 ml etidocaine 1% is injected, initially followed by 1 ml per segment of the total calculated analgesic dose. Analgesic spread, blood pressure, and pulse are checked every 2 min. If a sufficient effect is not reached within 20 min, a further 2 ml per segment is injected. The patient is sedated in the operating room with diazepam, droperidol, or chlorpromazine and receives 6-8 l O2 during spontaneous respiration via a Hudson mask. The epidural catheter is left in place for postoperative analgesia. Intubation is used only as required. Of a total of 52 patients, 31 (60%) did not require intubation, 24 (46%) were age 70 or older, and 31 (60%) were classified as ASA risk group III-IV. Thirty-three of all the procedures (63%) involved upper abdominal surgery (liver, gallbladder) and the majority of these received thoracic (Th 9-10) punctures, with the catheter inserted 5 cm in the epidural space; 88% were punctured medially and 12% laterally. The most frequent complications were bradycardia and hypotension. Respiratory arrest and aspiration were not seen. Thoracic epidural catheter anesthesia can be carried out with or without intubation and with a minimum of complications in selected procedures. Postoperative analgesia is an important advantage.