[Continuous thoracic epidural analgesia in surgical interventions on the upper half of the abdomen--the noninvasive monitoring of the early hemodynamic changes].
Operative interventions in the upper half of the abdomen have been performed in 32 surgical patients under thoracic epidural analgesia (TEA) with bupivacain at T4-L2 level, with the use of catheter technique. Before operation the patients were hydrated with 12.5 per cent of the circulating blood volume, calculated by nomogram. By noninvasive approach were monitored: pulse rate (PR), mean arterial pressure (MAP), minute cardiac volume (MCV), peripheral vascular resistance (PVR) and cardiac index (CI) for the following times; T0--basal preoperative value, T1--on the 5. min; T2--on the 10. min; T3--on the 15. min.; T4--on the 20 min.; T5--on the 50. min after application of bupivacain analgesia. The results were compared by variation analysis to T0. PVR was reduced with statistical significance for T2, T3 and T4 (p less than 0.01). MCV, CI and MAP tended to be reduced, while PR showed no significant changes. The results may be summarized, as follows: 1. Noninvasive monitoring of PR, MAP, MCV, CI and PVR in TEA is necessary for early detection and control of their pathologic changes; 2. The hemodynamic changes in TEA with bupivacain at T4-L2 level after premedication with vagolytic and hydration with Ringer-lactate (in amount 12.5 per cent of the circulating blood volume) are not significant and do not require additional treatment; 3, TEA at T4--L2 level allows performance of operative interventions in the upper half of the abdomen with adequate analgesia and relaxation, being particularly indicated for patients at risk.
V
V
Gadiuchkov
K
K
Nikolov
S
S
Lazarov
I
I
Atanasov
M
M
Benbasat
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D002045:Bupivacaine; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013909:Thorax
D002045:Bupivacaine
Prodŭlzhitelna torakalna epiduralna analgeziia pri operativni namesi v gornata polovina na korema--neinvazivno monitorirane na rannite khemodinamichni promeni.