title: [The positive effect of the 10 degree Trendelenburg position in patients undergoing epigastric surgery with lumbo-thoracic epidural anesthesia].
abstract: The authors administered to 60 patients, mean age 71 years, epidural anaesthesia on account of operations in the epigastrium. A solution of 0.5% bupivacaine without adrenaline in doses calculated according to Bromage for 18 segments was administered from a lateral approach in the upper part of the lumbar spine. After administration of the anaesthetic they tilted the patients to a 15-20 degrees Trendelenburg position. They adjusted the slope of the patients to ensure that the anaesthesia reached eventually the radicular zone of Th3. They made use of the finding that the anaesthetic solution in the epidural space tends to decline. After fixation of the anaesthetic to the nervous tissue, 30 patients were slowly changed to a horizontal position and the same number of patients was left throughout the operation in a Trendelenburg position. The authors made sure that the systolic blood pressure did not drop below 13.3 kPa in normotonics and beneath 60% of the initial value in hypertonic patients. There were no substantial differences in the ephedrine consumption per kg body weight within three hours after the puncture of the epidural space in the two groups. The total consumption of Hartmann solution, ketamine and diazepam was, however, significantly lower in patients who during operation were in the 10 degrees Trendelenburg position. The variations of blood pressure during traction of anatomical structures in the epigastrium were smaller in the latter patients. No serious disorders of the cardiac rhythm were recorded. None of the patients of the group died within seven days after operation.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Anesteziologické a resuscitacní oddĕlení NsP, Cáslav.
authors.forename: J
authors.initials: J
authors.lastname: Strnad
authors.forename: E
authors.initials: E
authors.lastname: Honců
authors.forename: J
authors.initials: J
authors.lastname: Kunásek
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011187:Posture
vernacular_title: Príznivý vliv 10 stupnu Trendelenburgovy polohy u nemocných operovaných v nadbrisku v lumbotorakálním epidurálním znecitlivĕním.