Use of a high thoracic epidural analgesia for treatment of end-stage congestive heart failure secondary to coronary artery disease: effect of HTEA on CHF.

We present the case of a patient with end-stage congestive heart failure (NYHA class IV) secondary to ischemic cardiomyopathy despite maximally medical therapy, who needed to have a coronary artery bypass graft (CABG) surgery but whose risk was considered too high due to his deteriorating cardiac function. Cardiac sympathetic blockade by high thoracic epidural analgesia (HTEA) was added to stabilize the patient's critical condition before surgery. HTEA was performed at the T1 through T5 levels with a catheter placed percutaneously and then lidocaine (0.5%, 3-5 ml) was given as intermittent injections through the epidural catheter. The combination of HTEA treatment resulted in a rapid hemodynamic and clinical improvement and no serious catheter-related complications occurred. This case suggests that HTEA seems to be an effective and safe adjuvant therapeutics and can be used as a short-term bridge to CABG or cardiac transplantation in patients with end-stage congestive heart failure.

Effect of thoracic epidural blockade on plasma fibrinogen levels in patients with dilated cardiomyopathy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effects of thoracic epidural blockade (TEB) on plasma fibrinogen (FIB) levels.</p><p><b>METHODS</b>Thirty cases of dilated cardiomyopathy (DCM) were selected randomly into a TEB group and a control group. TEB patients were subjected to a persistent TEB (T1 - 5), and injected with 0.5% lidocaine 3 - 5 ml every two or four hours for four weeks in addition to routine medicine, while patients in the control group were given routine medicine only. Plasma concentrations of FIB were measured using the micro-capillary assay. Doppler echocardiography was performed before and after the treatment.</p><p><b>RESULTS</b>Plasma concentrations of FIB in two groups were greater than the normal value before the treatment. There was a significant decrease of plasma concentrations of FIB in the TEB group after the treatment (4.2 +/- 1.3 g/L vs 3.6 +/- 0.9 g/L, P < 0.05), but there was no significant change in the control group (4.2 +/- 1.2 g/L vs 4.3 +/- 1.9 g/L, P > 0.05). After four weeks of treatment, the left ventricular end diastolic diameters (LVEDD) of TEB patients were reduced (72 +/- 10 mm vs 69 +/- 10 mm, P < 0.05) and the left ventricular ejection fraction (LVEF) of TEB patients increased significantly (33% +/- 13% vs 44% +/- 14%, P < 0.05). In contrast, LVEDD (73 +/- 11 mm vs 73 +/- 12 mm, P > 0.05) and LVEF (32% +/- 14% vs 33% +/- 12%, P > 0.05) did not change significantly in the control group.</p><p><b>CONCLUSIONS</b>The results suggest that plasma FIB levels in patients with DCM were decreased by performing a TEB, in addition to a reduction of the enlarged cardiac cavity and an improvement in cardiac systolic dysfunction. TEB might contribute to lowering the occurrence of thrombus and thromboembolism in patients with DCM. TEB might be a promising therapeutic method to improve the prognosis of DCM patients.</p>

High epidural blockade lowers serum free fatty acids level in patients with acute myocardial infarction / 中华麻醉学杂志

Objective: To explore whether high epidural blockade(HEB) can lower the elevated serum free fatty acids(FFA) level in the patients with acute myocardial infarction(AMI). Method:In 7 patients with AMI,HEB at T 15 was performed by injecting 5 to 7ml of 0.5%-0.75% lidocaine every 2 to 4 hours for 7 successive days;while the other 7 patients with AMI didn't use HEB as control. only morphine or dolantine was used for relieving angina cordis. Result: The elevated FFA level returned to normal range in 12 hours following HEB in the study group, but in one week in the control group. Conclusion:HEB(T1-5) can lower the elevated FFA level in AMI patients to normal within12 hours.