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Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function

(2019) ANESTHESIOLOGY. 130(3). p.472-491
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Abstract
Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia-induced sympatholysis and cardiovascular control mechanisms. Perhaps these new insights may help identify conditions in which benefits of thoracic epidural anesthesia may not outweigh potential risks. For example, cardiac sympathectomy with high-thoracic epidural anesthesia decreases right ventricular function and attenuates its capacity to cope with increased right ventricular afterload. Although the clinical significance of this pathophysiologic interaction is unknown at present, it identifies a subgroup of patients with established or pending pulmonary hypertension for whom outcome studies are needed. Other new areas of interest include the impact of thoracic epidural anesthesia-induced sympatholysis on cardiovascular control in conditions associated with increased sympathetic tone, surgical stress, and hemodynamic disruption. It was considered appropriate to collect and analyze all recent scientific information on this subject to provide a comprehensive update on the cardiovascular effects of high-thoracic epidural anesthesia and cardiac sympathectomy in healthy and diseased patients.
Keywords
LEFT-VENTRICULAR FUNCTION, MYOCARDIAL BLOOD-FLOW, REFRACTORY, ANGINA-PECTORIS, CORONARY-ARTERY OCCLUSION, BYPASS GRAFT-SURGERY, HEART-RATE, GENERAL-ANESTHESIA, HEMODYNAMIC-RESPONSE, BAROREFLEX, CONTROL, SYMPATHETIC-STIMULATION

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Citation

Please use this url to cite or link to this publication:

MLA
Wink, Jeroen, et al. “Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function.” ANESTHESIOLOGY, vol. 130, no. 3, 2019, pp. 472–91.
APA
Wink, J., Veering, B. T., Aarts, L. P., & Wouters, P. (2019). Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function. ANESTHESIOLOGY, 130(3), 472–491.
Chicago author-date
Wink, Jeroen, Bernadette T Veering, Leon PHJ Aarts, and Patrick Wouters. 2019. “Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function.” ANESTHESIOLOGY 130 (3): 472–91.
Chicago author-date (all authors)
Wink, Jeroen, Bernadette T Veering, Leon PHJ Aarts, and Patrick Wouters. 2019. “Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function.” ANESTHESIOLOGY 130 (3): 472–491.
Vancouver
1.
Wink J, Veering BT, Aarts LP, Wouters P. Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function. ANESTHESIOLOGY. 2019;130(3):472–91.
IEEE
[1]
J. Wink, B. T. Veering, L. P. Aarts, and P. Wouters, “Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function,” ANESTHESIOLOGY, vol. 130, no. 3, pp. 472–491, 2019.
@article{8621638,
  abstract     = {Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia-induced sympatholysis and cardiovascular control mechanisms. Perhaps these new insights may help identify conditions in which benefits of thoracic epidural anesthesia may not outweigh potential risks. For example, cardiac sympathectomy with high-thoracic epidural anesthesia decreases right ventricular function and attenuates its capacity to cope with increased right ventricular afterload. Although the clinical significance of this pathophysiologic interaction is unknown at present, it identifies a subgroup of patients with established or pending pulmonary hypertension for whom outcome studies are needed. Other new areas of interest include the impact of thoracic epidural anesthesia-induced sympatholysis on cardiovascular control in conditions associated with increased sympathetic tone, surgical stress, and hemodynamic disruption. It was considered appropriate to collect and analyze all recent scientific information on this subject to provide a comprehensive update on the cardiovascular effects of high-thoracic epidural anesthesia and cardiac sympathectomy in healthy and diseased patients.},
  author       = {Wink, Jeroen and Veering, Bernadette T and Aarts, Leon PHJ and Wouters, Patrick},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keywords     = {LEFT-VENTRICULAR FUNCTION,MYOCARDIAL BLOOD-FLOW,REFRACTORY,ANGINA-PECTORIS,CORONARY-ARTERY OCCLUSION,BYPASS GRAFT-SURGERY,HEART-RATE,GENERAL-ANESTHESIA,HEMODYNAMIC-RESPONSE,BAROREFLEX,CONTROL,SYMPATHETIC-STIMULATION},
  language     = {eng},
  number       = {3},
  pages        = {472--491},
  title        = {Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function},
  url          = {http://dx.doi.org/10.1097/ALN.0000000000002558},
  volume       = {130},
  year         = {2019},
}

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