Systemic, but not pulmonary, hemodynamics are depressed during combined high thoraco-cervical epidural and general anesthesia in dogs.
OBJECTIVE
An epidural block is frequently combined with general anesthesia. Both systemic and pulmonary hemodynamics may be affected by high epidural anesthesia and the combined general anesthetic. These effects were investigated in a canine model.


METHODS
Systemic and pulmonary hemodynamics during a combined high thoraco-cervical epidural and general anesthesia were studied in dogs; the animals were anesthetized with propofol, 10 mg.kg(-1).hr(-1), or 2% sevoflurane, and then 1% mepivacaine, 5 mL, was injected epidurally between T1 and T2. Cardiac output (CO), pulmonary capillary wedge pressure (PCWP), pulmonary arterial pressure (PAP), mean arterial pressure (MAP), central venous pressure (CVP), electrocardiogram, and arterial and mixed venous gases were monitored for over 90 min after epidural mepivacaine. The interval between sevoflurane and propofol studies was two hours.


RESULTS
Baseline measurement of MAP with sevoflurane anesthesia was significantly lower (P < 0.05-0.01) at every time point than with propofol anesthesia. After epidural mepivacaine (C1)-T7/8 blockade), MAP (P < 0.05-0.01), CO (P < 0.05-0.01), and heart rate (P < 0.05-0.01) decreased significantly during both propofol and sevoflurane anesthesia. In the sevoflurane group, stroke volume decreased significantly (P < 0.05-0.01) but recovered; however, MAP (P < 0.01) and CO (P < 0.05) did not recover 90 min after the injection. Mean CVP and systemic vascular resistance were not altered. There were no changes in mean PAP, mean PCWP, and pulmonary vascular resistance.


CONCLUSIONS
A combined high thoracic/general anesthesia depressed systemic hemodynamics, whereas the pulmonary circulation was not affected. The extent of the depression varied with the general anesthetics used, sevoflurane and propofol.
Departments of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan.
Tadahisa
T
Funayama
Sumihisa
S
Aida
Takashi
T
Matsukawa
Kazuo
K
Okada
Teruo
T
Kumazawa
D000704:Analysis of Variance; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D019162:Anesthetics, Combined / Q000494:pharmacology*; D000818:Animals; D002574:Cervical Vertebrae; D004285:Dogs; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D008619:Mepivacaine / Q000494:pharmacology; D008738:Methyl Ethers / Q000494:pharmacology; D023421:Models, Animal; D015742:Propofol / Q000494:pharmacology; D011652:Pulmonary Circulation / Q000187:drug effects*; D000077149:Sevoflurane; D013904:Thoracic Vertebrae; D013997:Time Factors
D019162:Anesthetics, Combined; D008738:Methyl Ethers; D000077149:Sevoflurane; D008619:Mepivacaine; D015742:Propofol