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Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery

OBJECTIVE: A substantial reduction in lung volumes and pulmonaryfunction follows cardiac surgery. Pain may prevent effective breathing andcoughing, and as thoracic epidural analgesia may reduce postoperative pain,we investigated the effect of epidural analgesia on pulmonary function.METHODS: Fifty-f...

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Published in:European journal of cardio-thoracic surgery 1996, Vol.10 (10), p.859-865
Main Authors: Stenseth, R, Bjella, L, Berg, E M, Christensen, O, Levang, O W, Gisvold, S E
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container_end_page 865
container_issue 10
container_start_page 859
container_title European journal of cardio-thoracic surgery
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creator Stenseth, R
Bjella, L
Berg, E M
Christensen, O
Levang, O W
Gisvold, S E
description OBJECTIVE: A substantial reduction in lung volumes and pulmonaryfunction follows cardiac surgery. Pain may prevent effective breathing andcoughing, and as thoracic epidural analgesia may reduce postoperative pain,we investigated the effect of epidural analgesia on pulmonary function.METHODS: Fifty-four male patients, under 65 years and with an ejectionfraction of more than 0.5, were randomized into two groups: a control groupreceiving high-dose fentanyl anaesthesia and an epidural group receivinglow-dose fentanyl anaesthesia + thoracic epidural analgesia. Time toawakening and time to extubation were recorded. Further, spirometric data,arterial oxygenation, pulmonary shunt, haemodynamics, use of vasoactivedrugs and fluid balance were followed for up to 6 days postoperatively.RESULTS: Patients with low-dose fentanyl and epidural analgesia awoke (1.6vs 3.6 h) and were extubated (5.4 vs 10.8 h) significantly earlier thancontrol group patients. A 50-70% reduction in forced vital capacity, forcedexpiratory volume in 1 s (FEV1.0) and peak expiratory flow rate (PEFR) wasseen after surgery, but higher FEV1.0 and PEFR on days 2 and 3 were seen inthe epidural group than in the control group. Pulmonary shunt andalveolo-arterial oxygen difference increased similarly in both groups,whereas oxygen delivery and mixed venous oxygen saturation were higher inthe epidural group. Epidural analgesia gave better control of thepostoperative hyperdynamic circulation. CONCLUSIONS: Thoracic epiduralanalgesia yields a slight, but significant, improvement in pulmonaryfunction, most likely due to a more profound postoperative analgesia.
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Pain may prevent effective breathing andcoughing, and as thoracic epidural analgesia may reduce postoperative pain,we investigated the effect of epidural analgesia on pulmonary function.METHODS: Fifty-four male patients, under 65 years and with an ejectionfraction of more than 0.5, were randomized into two groups: a control groupreceiving high-dose fentanyl anaesthesia and an epidural group receivinglow-dose fentanyl anaesthesia + thoracic epidural analgesia. Time toawakening and time to extubation were recorded. Further, spirometric data,arterial oxygenation, pulmonary shunt, haemodynamics, use of vasoactivedrugs and fluid balance were followed for up to 6 days postoperatively.RESULTS: Patients with low-dose fentanyl and epidural analgesia awoke (1.6vs 3.6 h) and were extubated (5.4 vs 10.8 h) significantly earlier thancontrol group patients. A 50-70% reduction in forced vital capacity, forcedexpiratory volume in 1 s (FEV1.0) and peak expiratory flow rate (PEFR) wasseen after surgery, but higher FEV1.0 and PEFR on days 2 and 3 were seen inthe epidural group than in the control group. Pulmonary shunt andalveolo-arterial oxygen difference increased similarly in both groups,whereas oxygen delivery and mixed venous oxygen saturation were higher inthe epidural group. Epidural analgesia gave better control of thepostoperative hyperdynamic circulation. 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Pain may prevent effective breathing andcoughing, and as thoracic epidural analgesia may reduce postoperative pain,we investigated the effect of epidural analgesia on pulmonary function.METHODS: Fifty-four male patients, under 65 years and with an ejectionfraction of more than 0.5, were randomized into two groups: a control groupreceiving high-dose fentanyl anaesthesia and an epidural group receivinglow-dose fentanyl anaesthesia + thoracic epidural analgesia. Time toawakening and time to extubation were recorded. Further, spirometric data,arterial oxygenation, pulmonary shunt, haemodynamics, use of vasoactivedrugs and fluid balance were followed for up to 6 days postoperatively.RESULTS: Patients with low-dose fentanyl and epidural analgesia awoke (1.6vs 3.6 h) and were extubated (5.4 vs 10.8 h) significantly earlier thancontrol group patients. A 50-70% reduction in forced vital capacity, forcedexpiratory volume in 1 s (FEV1.0) and peak expiratory flow rate (PEFR) wasseen after surgery, but higher FEV1.0 and PEFR on days 2 and 3 were seen inthe epidural group than in the control group. Pulmonary shunt andalveolo-arterial oxygen difference increased similarly in both groups,whereas oxygen delivery and mixed venous oxygen saturation were higher inthe epidural group. Epidural analgesia gave better control of thepostoperative hyperdynamic circulation. 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Pain may prevent effective breathing andcoughing, and as thoracic epidural analgesia may reduce postoperative pain,we investigated the effect of epidural analgesia on pulmonary function.METHODS: Fifty-four male patients, under 65 years and with an ejectionfraction of more than 0.5, were randomized into two groups: a control groupreceiving high-dose fentanyl anaesthesia and an epidural group receivinglow-dose fentanyl anaesthesia + thoracic epidural analgesia. Time toawakening and time to extubation were recorded. Further, spirometric data,arterial oxygenation, pulmonary shunt, haemodynamics, use of vasoactivedrugs and fluid balance were followed for up to 6 days postoperatively.RESULTS: Patients with low-dose fentanyl and epidural analgesia awoke (1.6vs 3.6 h) and were extubated (5.4 vs 10.8 h) significantly earlier thancontrol group patients. A 50-70% reduction in forced vital capacity, forcedexpiratory volume in 1 s (FEV1.0) and peak expiratory flow rate (PEFR) wasseen after surgery, but higher FEV1.0 and PEFR on days 2 and 3 were seen inthe epidural group than in the control group. Pulmonary shunt andalveolo-arterial oxygen difference increased similarly in both groups,whereas oxygen delivery and mixed venous oxygen saturation were higher inthe epidural group. Epidural analgesia gave better control of thepostoperative hyperdynamic circulation. CONCLUSIONS: Thoracic epiduralanalgesia yields a slight, but significant, improvement in pulmonaryfunction, most likely due to a more profound postoperative analgesia.</abstract><cop>Germany</cop><pub>Elsevier Science B.V</pub><pmid>8911839</pmid><doi>10.1016/S1010-7940(96)80311-3</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source Oxford University Press:Jisc Collections:OUP Read and Publish 2024-2025 (2024 collection) (Reading list)
subjects Adult
Analgesia, Epidural
Anesthesia Recovery Period
Anesthesia, General
Coronary Artery Bypass
Dose-Response Relationship, Drug
Fentanyl
Humans
Lung - blood supply
Lung Volume Measurements
Male
Middle Aged
Pain, Postoperative - drug therapy
Pain, Postoperative - physiopathology
Regional Blood Flow - drug effects
title Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery
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