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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Biventricular function in exercise during autonomic (thoracic epidural) block.

Jeroen Wink1, Paul Steendijk2, Roula Tsonaka3

  • 1Department of Anesthesiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. j.wink@lumc.nl.

European Journal of Applied Physiology
|February 22, 2021
PubMed
Summary
This summary is machine-generated.

Thoracic epidural anesthesia (TEA) reduces cardiac systolic function, but does not blunt exercise-induced improvements. This suggests other mechanisms regulate cardiac function during physical stress.

Keywords:
AnesthesiaAutonomicCirculationEpiduralExerciseNervous systemVentricular function, leftVentricular function, right

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Physiology

Background:

  • Thoracic epidural anesthesia (TEA) blocks cardiac sympathetic fibers, reducing ventricular systolic function and pulmonary arterial elastance.
  • Previous studies showed TEA did not alter cardiac output or systemic hemodynamics at rest with controlled heart rate.

Purpose of the Study:

  • To investigate the effects of cardiac sympathicolysis via TEA during physical stress and increased oxygen demand.
  • To assess the impact of TEA on biventricular function and hemodynamics during dynamic exercise.

Main Methods:

  • A crossover design study involving 12 patients undergoing thoracic surgery.
  • Patients performed dynamic ergometric exercise tests with and without TEA.
  • Hemodynamics and biventricular function were monitored using echocardiography and Doppler imaging.

Main Results:

  • TEA attenuated right ventricular (RV) and left ventricular (LV) systolic function (RV S': -21%, LV S': -14%).
  • TEA decreased heart rate, stroke volume index, cardiac index, and mean arterial pressure, but not systemic vascular resistance.
  • Exercise significantly augmented biventricular systolic and diastolic function, with no significant interaction with TEA, except for rate-pressure product and LV end-diastolic velocity.

Conclusions:

  • Cardiac sympathetic blockade with TEA reduces LV and RV systolic function.
  • TEA did not blunt exercise-induced increases in LV and RV function, indicating other regulatory mechanisms are involved.
  • Additional mechanisms beyond the cardiac sympathetic nervous system regulate cardiac function during dynamic exercise.