ABSTRACT
STUDY OBJECTIVE: To compare circulatory variables to an abrupt increase in isoflurance concentration via mask in patients who received either upper thoracic or lumbar epidural anesthesia, or neither. DESIGN: Prospective study. SETTING: Operating room at a university hospital. PATIENTS: 45 ASA physical status I female patients scheduled for elective surgeries with general anesthesia. INTERVENTIONS: Patients received thoracic (TEA group) or lumbar (LEA group) epidural anesthesia, or neither (control group) (n = 15 per group). An epidural catheter was inserted through the T1-T2 intervertebral space in the TEA group or L2-L3 in the LEA group, and 10 mL of 2% lidocaine without epinephrine was injected. Two minutes after induction of anesthesia with thiamylal, the inspired isoflurane concentration was rapidly increased from 0.5% to 5% and maintained for 5 minutes. MEASUREMENTS AND MAIN RESULTS: Heart rate and mean arterial pressure (MAP) were measured every minute. Mean analgesic levels obtained by epidural block were C4-T6 and T10-S1 in the TEA and LEA groups, respectively. Heart rate increased after the increase in isoflurane concentration in all groups, but increased significantly less in the TEA group than in the control or LEA groups (p < 0.05). Isoflurane also increased MAP in the control group throughout the 5-minute period, but only at the first minute of inhalation in the TEA and LEA groups. The increases in MAP in the TEA and LEA groups were significantly less than that in the control group (p < 0.05). CONCLUSION: Epidural anesthesia can blunt circulatory responses to a sudden increase in isoflurane concentration.
Subject(s)
Anesthesia, Epidural/classification , Anesthetics, Inhalation/administration & dosage , Blood Pressure/drug effects , Heart Rate/drug effects , Heart/drug effects , Isoflurane/administration & dosage , Adult , Analysis of Variance , Anesthesia, Epidural/methods , Anesthesia, Intravenous , Anesthetics, Intravenous/administration & dosage , Anesthetics, Local/administration & dosage , Elective Surgical Procedures , Electrocardiography/drug effects , Female , Humans , Lidocaine/administration & dosage , Lumbar Vertebrae , Middle Aged , Oxygen/blood , Prospective Studies , Thiamylal/administration & dosage , Thoracic VertebraeABSTRACT
En pacientes ASA I y II, se evalúa las ventajas que tiene la adición de un narcótico, en este caso el fentanil (100 ug), a la solución del anestésico local (lidoca{ina al 2 por ciento con epinefrina 1:200.000(13cc). La presión arterial sitólica desciende en un 10 por ciento del valor inicial a los 5 minutos retornando a los valores basales aproxidamente a los quince minutos, la frecuencia cardíaca sufre pocas variaciones, sin significación clínica ni estadística. El APGAR del recién nacido tiene una media de (8.5) al primer minuto, y de 9.8) a los cinco minutos. No se reportó complicaciones inherentes a la técnica anestésica durante el seguimiento que se realizó de los niñoa a las 12 y 24 horas...
