The effects of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics in patients with severe chronic obstructive pulmonary disease.
Optimal analgesia is important after thoracotomy in pulmonary-limited patients to avoid pain-related pulmonary complications. Thoracic epidural anesthesia (TEA) can provide excellent pain relief. However, potential paralysis of respiratory muscles and changes in bronchial tone might be unfavorable in patients with end-stage chronic obstructive pulmonary disease (COPD). Therefore, we evaluated the effect of TEA on maximal inspiratory pressure, pattern of breathing, ventilatory mechanics, and gas exchange in 12 end-stage COPD patients. Pulmonary resistance, work of breathing, dynamic intrinsic positive end-expiratory pressure, and peak inspiratory and expiratory flow rates were evaluated by assessing esophageal pressure and airflow. An increase in minute ventilation (7.50 +/- 2.60 vs 8.70 +/- 2.10 L/min; P = 0.04) by means of increased tidal volume (0.46 +/- 0.16 vs 0.53 +/- 0.14 L/breath; P = 0.003) was detected after TEA. These changes were accompanied by an increase in peak inspiratory flow rate (0.48 +/- 0.17 vs 0.55 +/- 0.14 L/s; P = 0.02) and a decrease in pulmonary resistance (20.7 +/- 9.9 vs 16.6 +/- 8.1 cm H(2)O. L(-1). s(-1); P = 0.02). Peak expiratory flow rate, dynamic intrinsic positive end-expiratory pressure, work of breathing, PaO(2), and maximal inspiratory pressure were unchanged (all P > 0.50). We conclude that TEA with bupivacaine 0.25% can be used safely in end-stage COPD patients.


CONCLUSIONS
Thoracic epidural anesthesia with bupivacaine 0.25% does not impair ventilatory mechanics and inspiratory respiratory muscle strength in severely limited chronic obstructive pulmonary disease patients. Thus, thoracic epidural anesthesia can be used safely in patients with end-stage chronic obstructive pulmonary disease.
Department of Cardiothoracic and Vascular Anesthesia & Intensive Care Medicine, University of Vienna, Austria.
E M
EM
Gruber
E M
EM
Tschernko
M
M
Kritzinger
E
E
Deviatko
W
W
Wisser
D
D
Zurakowski
W
W
Haider
D000328:Adult; D000368:Aged; D000403:Airway Resistance; D015360:Analgesia, Epidural; D000779:Anesthetics, Local; D002045:Bupivacaine; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D008173:Lung Diseases, Obstructive / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000187:drug effects*; D012132:Respiratory Muscles / Q000187:drug effects / Q000502:physiology; D014797:Vital Capacity; D014939:Work of Breathing
D000779:Anesthetics, Local; D002045:Bupivacaine