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Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery
Author(s) -
Tenling A.,
Joachimsson P.O.,
Tydén H.,
Hedenstierna G.
Publication year - 2000
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2000.440906.x
Subject(s) - medicine , anesthesia , general anaesthesia , vital capacity , pulmonary function testing , tidal volume , respiratory minute volume , ventilation (architecture) , cardiothoracic surgery , respiratory system , surgery , lung , lung function , mechanical engineering , diffusing capacity , engineering
Background: A lasting impairment of pulmonary function is common after cardiac surgery. Pain from the sternotomy may contribute to the impairment. Thoracic epidural analgesia (TEA) can efficiently relieve pain in the postoperative phase, but may also affect respiratory muscle function if local anaesthetics are used. We examined the effects of TEA on pulmonary function and ventilation at rest, before and after coronary artery bypass graft surgery (CABG). Methods: Thirty patients scheduled for CABG were randomized to receive either general anaesthesia alone or general anaesthesia with TEA. Before and after the operation the patients were examined by respiratory inductive plethysmography and spirometric tests. Results: Before the operation, TEA caused significant reductions in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), maximal inspiratory (P I max) and expiratory (P E max) pressure. The rib cage contribution to tidal volume decreased significantly but the co‐ordination of the thoracic and abdominal movements remained essentially unaffected. Minute volume and respiratory frequency did not change significantly. On the first postoperative day a decrease in maximal breathing efforts was found in both groups. No differences between the groups in FVC, FEV1 and P I max were found, but P E max was significantly greater in the TEA group. Despite the impairment, breathing at rest was largely normal in both groups. Conclusions: A better pain‐relief from TEA after CABG may improve the ability to cough by a greater expiratory muscle strength. FVC, FEV1, P I max and breathing at rest are not affected by TEA after cardiac surgery.