[Continuous thoracic epidural anesthesia in abdominal surgery]

General anesthesia, applied under emergency conditions in both geriatric patients and patients presenting considerable in severity concomitant diseases (pulmonary and cardiovascular), is associated with serious risks in terms of restoring adequate consciousness, effective spontaneous respiration and pulmonary drainage, not infrequently requiring continuous mechanical ventilation of the patients. A procedure alternative to general anesthesia in abdominal surgery is described, consisting in the application of continuous thoracic epidural anesthesia (CTEDA), reaching i.v. thoracic segment, providing for analgesia of the whole abdomen and myorelaxation promoting accomplishment of the operative intervention against the background of preserved consciousness and spontaneous respiration. This is a report on 70 patients operated under CTEDA in the clinic of emergency surgery, University Hospital "Queen Giovanna"--Sofia, in the period June 1994 through April 1998. The methodology, superiorities and general organic effects of this particular type of anesthesia are comprehensively discussed. Emphasis is laid on the important role played by CTEDA in postoperative analgesia of patients in intensive care units, and on the contribution of the method to exclude any opiates, till recently considered as the most effective for pain relief in the post-operative period.