Combined thoracic epidural and light general anaesthesia for upper abdominal surgery in high risk patients

ABSTRACT

The goal of the study was to assess the safety and effectiveness of the thoracic epidural anesthesia [TEA] in high risk patients undergoing upper abdominal surgery. Quasi Experimental. Department of anaesthesia, Liaquat National Hospital, Karachi from August 2002 - July 2003. 20 adult patients aged between 50 - 70 years were selected with ASA status III and IV. TEA was performed in sitting position at the level of T7 -T8 using hanging drop method. Titrated doses of 0.25%. Bupivacaine and 1% Xylocaine was injected 1 ml / dermatome through the catheter, anesthetic levels achieved were found to be T4 - T10. Light general anesthesia was instituted by using I/V propofol 50 - 60 mg, I/V Nalbuphine 5 - 7.5 mg and Midazolam 1.5 - 2 mg I/V. Total dose of local anesthetic varied from 12 -18 ml [mean 16 ml]. Two patients had bradycardia with heart rate less than 60 beats/min treated with atropine. Two patients had hypotension treated with titrated doses of ephedrine and I/V Ringer's solution. Our results were very promising and we can state confidently that thoracic epidural is a viable option and safe alternative, reducing morbidity in high risk patients