Thoracic Epidural Analgesia (thoracic + epidural_analgesia)

Distribution by Scientific Domains


Selected Abstracts


Thoracic epidural anaesthesia and analgesia: United Kingdom practice

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2000
F. O'Higgins
Background: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists. Methods: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom. Results: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia. Conclusion: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up. [source]


Does thoracic epidural analgesia improve systolic and diastolic functions by improved myocardial oxygenation in patients with coronary artery disease?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009
S.-E. RICKSTEN
No abstract is available for this article. [source]


High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009
C.-J. JAKOBSEN
Background: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease. Methods: The effect of a high epidural block (at least Th1,Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E,) and atrial (A,) peak velocities during diastole. Results: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 1.53 to 6.86 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E,/A, ratio increased from 0.75 0.27 to 1.09 0.32 (P=0.0026), indicating improved relaxation. Conclusion: A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease. [source]


Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2006
P. Hannemann
Background:, For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. Methods:, In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results:, The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2,3 h before anaesthesia. Solid food was permitted up to 6,8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. Conclusion:, In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome. [source]


Can chronic poststernotomy pain after cardiac valve replacement be reduced using thoracic epidural analgesia?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2004
M. K. Jensen
Background:, The aim of our study was to evaluate the use of thoracic epidural analgesia (TEA) in acute pain management after cardiac valve replacement and determine if the incidence of chronic pain related to the sternotomy was reduced by the use of TEA. This patient group was chosen to exclude pain related to the use of the internal mammary artery and angina pectoris. Methods:, Patients scheduled for elective cardiac valve replacement were offered TEA. A match-control group was selected. Epidural catheter placement, complications and postoperative neurological state were noted for both groups. Eighteen months postoperatively, a questionnaire was sent out concerning pain management, wound discomfort and pain. Results:, Forty-nine patients were included. The TEA group consisted of 35 patients. At 18 months' follow up, 37% from the TEA group and 21% from the control group had pain or discomfort related to the sternum (NS). Two in the TEA group had severe pain. Conclusion:, We found in our small material that TEA provided excellent analgesia in the peri- and postoperative period, but we did not find a protective effect of TEA on chronic poststernotomy pain, neither weak pain nor severe pain. [source]


Thoracic epidural anaesthesia and analgesia: United Kingdom practice

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2000
F. O'Higgins
Background: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists. Methods: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom. Results: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia. Conclusion: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up. [source]


A combination of total intravenous anesthesia and thoracic epidural for thymectomy in juvenile myasthenia gravis

PEDIATRIC ANESTHESIA, Issue 4 2007
OLIVER BAGSHAW MBChB FRCAArticle first published online: 12 DEC 200
Summary Juvenile myasthenia gravis is the acquired form of the disease in children and presents with ocular signs, fatigability, weakness and bulbar problems. The majority of patients demonstrate thymic hyperplasia and have been shown to benefit from thymectomy. The main considerations for the anesthesiologist are the degree of muscle weakness, the muscle groups involved and sensitivity to neuromuscular blocking drugs and volatile agents. Total intravenous anesthesia (TIVA) with epidural analgesia is probably the anesthetic technique of choice, although the latter is often avoided, because of the risk of a very high block. Two cases of thymectomy are presented where anesthesia was provided using a combination of TIVA and thoracic epidural analgesia. Both patients tolerated the technique well and had an uncomplicated perioperative course. [source]


Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures

ANAESTHESIA, Issue 1 2001
G. A. McLeod
Six hundred and forty patients received epidural analgesia for postoperative pain relief following major surgery in the 6-year period 1993,1998. Although satisfactory pain relief was achieved in over two-thirds of patients for a median duration of 44 h after surgery, one-fifth of patients (133 individuals) still experienced poor pain relief. Almost one out of three patients (194 individuals) had a problem with their epidural. Eighty-three patients (13%) suffered a technical failure and 84 (13%) patients had their epidurals removed at night time when pain-free because of pressure on beds. Seven patients had their epidural replaced and subsequently experienced excellent pain relief for a median of 77 h. Lack of resources prevented a further 480 patients from receiving the potential benefits of epidural analgesia. These results would suggest that the practical problems of delivering an epidural service far outweigh any differences in drug regimens or modes of delivery of epidural solutions. [source]