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Echocardiographic evaluation of global left ventricular function during high thoracic epidural anesthesia
Y Niimi1, F Ichinose, H Saegusa
1Department of Anesthesia, Teikyo University School of Medicine, Chiba, Japan.
Journal of Clinical Anesthesia
|March 1, 1997
Summary
High thoracic epidural anesthesia reduces cardiac output but preserves left ventricular systolic and diastolic function in healthy individuals. This finding is crucial for understanding anesthetic effects on the heart.
Area of Science:
- Anesthesiology
- Cardiology
- Physiology
Background:
- Thoracic epidural anesthesia is used for surgical procedures.
- Its effects on cardiac function, particularly left ventricular performance, require detailed assessment.
Purpose of the Study:
- To evaluate the impact of high thoracic epidural anesthesia on left ventricular (LV) diastolic filling and systolic function.
- To compare these effects with low thoracic epidural anesthesia in patients without pre-existing heart conditions.
Main Methods:
- A prospective study involving 24 healthy patients undergoing elective noncardiac surgery.
- Patients received either high thoracic (HTE) or low thoracic (LTE) epidural anesthesia.
- Left ventricular function was assessed noninvasively using echocardiography with pulsed Doppler and acoustic quantification (AQ).
Main Results:
- High thoracic epidural anesthesia led to significant decreases in systolic blood pressure, heart rate, and cardiac output (CO).
- End-diastolic and end-systolic areas increased, maintaining stroke volume, while fractional area change decreased.
- Diastolic filling indices (E, A, E/A ratio) and AQ-derived parameters (D1, D2) remained unchanged in the HTE group.
- The LTE group showed no significant changes in measured cardiac indices.
Conclusions:
- High thoracic epidural anesthesia decreases cardiac output in healthy individuals.
- Despite reduced CO, left ventricular ejection and diastolic filling performance are preserved.
- Low thoracic epidural anesthesia does not significantly alter these cardiac parameters.