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Canadian Journal of Anesthesia, Vol 13, 541-549, Copyright © 1966 by Canadian Anesthesiologists' Society

The Cardiocirculatory Effects of Upper Thoracic Epidural Analgesia

PAUL E. OTTON M.D., F.R.C.P.(C)1 and EDITH J. WILSON M.D., CH.B., D.A.1

1 Department of Anaesthesia and Department of Surgery, McGill University and the Royal Victoria Hospital, Montreal

In order to isolate and identify the extent of cardiocirculatory changes following epidural analgesia, six fit preoperative patients were studied in the control state and after upper thoracic epidural block. Cardiocirculatory dynamics were assessed by measuring arterial and central venous pressures, heart rate, and cardiac output (Indocyanine dilution) and calculating total systemic vascular resistance and left ventricular work.

Following epidural blockade there was a significant reduction in cardiac index (16%) and in heart rate, whereas the stroke volume remained constant in spite of a significant rise in central venous pressure (1.9 cm. H2O). A decline in arterial pressure (7%) paralleled the reduction in minute flow. It is concluded that upper thoracic epidural analgesia reduces cardiac performance by interfering with fundamental cardiac mechanisms in two ways: firstly, by slowing the heart rate, and secondly, by reducing the myocardial response to its filling pressure.

Note:

Presented in part at the Annual Meeting of the Canadian Anaesthetists' Society at Banff, June 1966. This investigation was supported in part by a U.S.P.H.S. Grant and the Medical Research Council, Grant MA 1008.






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Copyright © 1966 by the Canadian Anesthesiologists' Society.