title: Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters.
abstract: BACKGROUND
  Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3-T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied.
  
  
  METHODS
  Thirty-five lung surgery patients were included in three age groups. Thirty-one patients received an epidural catheter at the T3-T4 interspace followed by an injection of 8-ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV).
  
  
  RESULTS
  There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P < 0.001), mean arterial pressure (16.1 ± 15.6, P < 0.001), CI (0.55 ± 0.49, P < 0.001) and SV (9.6 ± 14.6, P = 0.001) decreased after TEA for the total group. Maximal reduction in heart rate after TEA was more extensive in the young age group compared with the other age groups. There was no effect of age on other cardiovascular parameters.
  
  
  CONCLUSIONS
  We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.
authors: Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands. j.wink@lumc.nl
authors: J
authors: J
authors: Wink
authors: R
authors: R
authors: Wolterbeek
authors: L P H J
authors: LP
authors: Aarts
authors: S C E
authors: SC
authors: Koster
authors: M I M
authors: MI
authors: Versteegh
authors: B T H
authors: BT
authors: Veering
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000577:Amides / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004058:Diffusion; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block; D009431:Neural Conduction / Q000187:drug effects*; D018700:Pleurodesis; D000077212:Ropivacaine; D013318:Stroke Volume / Q000187:drug effects; D020775:Thoracic Surgery, Video-Assisted; D013904:Thoracic Vertebrae; D013908:Thoracotomy; D014018:Tissue Distribution; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine