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Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling

(2016) CIRCULATION. 134(16). p.1163-1175
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Abstract
Background: Blockade of cardiac sympathetic fibers by thoracic epidural anesthesia may affect right ventricular function and interfere with the coupling between right ventricular function and right ventricular afterload. Our main objectives were to study the effects of thoracic epidural anesthesia on right ventricular function and ventricular-pulmonary coupling. Methods: In 10 patients scheduled for lung resection, right ventricular function and its response to increased afterload, induced by temporary, unilateral clamping of the pulmonary artery, was tested before and after induction of thoracic epidural anesthesia using combined pressure-conductance catheters. Results: Thoracic epidural anesthesia resulted in a significant decrease in right ventricular contractility (ESV25: +25.5 mL, P=0.0003; Ees: -0.025 mmHg/mL, P=0.04). Stroke work, dP/dt(MAX), and ejection fraction showed a similar decrease in systolic function (all P<0.05). A concomitant decrease in effective arterial elastance (Ea: -0.094 mmHg/mL, P=0.004) yielded unchanged ventricular-pulmonary coupling. Cardiac output, systemic vascular resistance, and mean arterial blood pressure were unchanged. Clamping of the pulmonary artery significantly increased afterload (Ea: +0.226 mmHg/mL, P<0.001). In response, right ventricular contractility increased (ESV25: -26.6 mL, P=0.0002; Ees: +0.034 mmHg/mL, P=0.008), but ventricular-pulmonary coupling decreased ((Ees/Ea) = -0.153, P<0.0001). None of the measured indices showed significant interactive effects, indicating that the effects of increased afterload were the same before and after thoracic epidural anesthesia. Conclusions: Thoracic epidural anesthesia impairs right ventricular contractility but does not inhibit the native positive inotropic response of the right ventricle to increased afterload. Right ventricular-pulmonary arterial coupling was decreased with increased afterload but not affected by the induction of thoracic epidural anesthesia. Clinical Trial Registration: URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2844. Unique identifier: NTR2844.
Keywords
PRESSURE-VOLUME RELATIONSHIP, SINGLE-BEAT ESTIMATION, HEMODYNAMIC-RESPONSE, CONDUCTANCE CATHETER, LOAD DEPENDENCE, CARDIAC-OUTPUT, HEART-FAILURE, HYPERTENSION, THERMODILUTION, CONTRACTILITY, anesthesia, epidural, circulation, contractility, hemodynamics, pressure-volume relationship, pulmonary hypertension, ventricular, function, right

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MLA
Wink, Jeroen et al. “Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function with Maintained Ventricular-pulmonary Coupling.” CIRCULATION 134.16 (2016): 1163–1175. Print.
APA
Wink, J., de Wilde, R. B., Wouters, P., van Dorp, E. L., Veering, B. T., Versteegh, M. I., Aarts, L. P., et al. (2016). Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling. CIRCULATION, 134(16), 1163–1175.
Chicago author-date
Wink, Jeroen, Rob BP de Wilde, Patrick Wouters, Eveline LA van Dorp, Bernadette Th Veering, Michel IM Versteegh, Leon PHJ Aarts, and Paul Steendijk. 2016. “Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function with Maintained Ventricular-pulmonary Coupling.” Circulation 134 (16): 1163–1175.
Chicago author-date (all authors)
Wink, Jeroen, Rob BP de Wilde, Patrick Wouters, Eveline LA van Dorp, Bernadette Th Veering, Michel IM Versteegh, Leon PHJ Aarts, and Paul Steendijk. 2016. “Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function with Maintained Ventricular-pulmonary Coupling.” Circulation 134 (16): 1163–1175.
Vancouver
1.
Wink J, de Wilde RB, Wouters P, van Dorp EL, Veering BT, Versteegh MI, et al. Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling. CIRCULATION. 2016;134(16):1163–75.
IEEE
[1]
J. Wink et al., “Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling,” CIRCULATION, vol. 134, no. 16, pp. 1163–1175, 2016.
@article{8508510,
  abstract     = {Background: Blockade of cardiac sympathetic fibers by thoracic epidural anesthesia may affect right ventricular function and interfere with the coupling between right ventricular function and right ventricular afterload. Our main objectives were to study the effects of thoracic epidural anesthesia on right ventricular function and ventricular-pulmonary coupling. 
Methods: In 10 patients scheduled for lung resection, right ventricular function and its response to increased afterload, induced by temporary, unilateral clamping of the pulmonary artery, was tested before and after induction of thoracic epidural anesthesia using combined pressure-conductance catheters. 
Results: Thoracic epidural anesthesia resulted in a significant decrease in right ventricular contractility (ESV25: +25.5 mL, P=0.0003; Ees: -0.025 mmHg/mL, P=0.04). Stroke work, dP/dt(MAX), and ejection fraction showed a similar decrease in systolic function (all P<0.05). A concomitant decrease in effective arterial elastance (Ea: -0.094 mmHg/mL, P=0.004) yielded unchanged ventricular-pulmonary coupling. Cardiac output, systemic vascular resistance, and mean arterial blood pressure were unchanged. Clamping of the pulmonary artery significantly increased afterload (Ea: +0.226 mmHg/mL, P<0.001). In response, right ventricular contractility increased (ESV25: -26.6 mL, P=0.0002; Ees: +0.034 mmHg/mL, P=0.008), but ventricular-pulmonary coupling decreased ((Ees/Ea) = -0.153, P<0.0001). None of the measured indices showed significant interactive effects, indicating that the effects of increased afterload were the same before and after thoracic epidural anesthesia. 
Conclusions: Thoracic epidural anesthesia impairs right ventricular contractility but does not inhibit the native positive inotropic response of the right ventricle to increased afterload. Right ventricular-pulmonary arterial coupling was decreased with increased afterload but not affected by the induction of thoracic epidural anesthesia. Clinical Trial Registration: URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2844. Unique identifier: NTR2844.},
  author       = {Wink, Jeroen and de Wilde, Rob BP and Wouters, Patrick and van Dorp, Eveline LA and Veering, Bernadette Th and Versteegh, Michel IM and Aarts, Leon PHJ and Steendijk, Paul},
  issn         = {0009-7322},
  journal      = {CIRCULATION},
  keywords     = {PRESSURE-VOLUME RELATIONSHIP,SINGLE-BEAT ESTIMATION,HEMODYNAMIC-RESPONSE,CONDUCTANCE CATHETER,LOAD DEPENDENCE,CARDIAC-OUTPUT,HEART-FAILURE,HYPERTENSION,THERMODILUTION,CONTRACTILITY,anesthesia,epidural,circulation,contractility,hemodynamics,pressure-volume relationship,pulmonary hypertension,ventricular,function,right},
  language     = {eng},
  number       = {16},
  pages        = {1163--1175},
  title        = {Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling},
  url          = {http://dx.doi.org/10.1161/CIRCULATIONAHA.116.022415},
  volume       = {134},
  year         = {2016},
}

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