Abstract
This study was designed to determine the haemodynamic effects of epidural epinephrine, 5 μg · ml- 1, added to bupivacaine, 0.75 per cent, in elderly patients with cardiac disease undergoing peripheral vascular surgery (PVS). The effect of epidural epinephrine on the plasma concentration of bupivacaine was also measured. Twenty patients with a history andlor ECG evidence ofmyocardial ischaemia requiring PVS were randomly assigned to two groups. The patients were monitored with a modified V5 ECG, oscillometric BP monitor and a PA catheter. After control haemodynamic measurements, 12 ml of bupivacaine, 0.75 per cent, ± epinephrine, 5 μg· ml- 1, was injected over five minutes into the epidural space at L3-4. Supine haemodynamic measurements were repeated at 15 and 45 min after injection. At 15 min after epidural injection, compared with control values, patients receiving epidural epinephrine showed a significantly greater decrease in mean blood pressure and systemic vascular resistance, and a significantly greater increase in cardiac output than patients receiving plain epidural bupivacaine (79.3 ± 11.6 per cent vs94.6 ± 16.8per cent, 61.6 ± 9.0 vs 91.6± 19.2 per cent, 130.8 ± 23 vs 105 ± 20.8 per cent, respectively). These differences were not present at 45 min after epidural injection. Heart rate was not significantly different between groups at either time. The presence of epidural epinephrine reduced the peak plasma concentration of bupivacaine from 0.86 ± 0.20 to 0.64 ± 0.33 μg · ml- 1 and increased the time to achieve this concentration from 16.1 ± 11.2 to 33.7 ± 20.1 min.
Résumé
Cette étude était conçue afin de déterminer les effets hémodynamiques de 5 μg· ml- 1 d’épinephrine en épidurale ajouté à la bupivacaïne, 0.75 pour cent, chez les patients âgés atteints de maladie cardiaque et devant subir une chirurgie vasculaire périphérique (PVS). L’effet de l’épinéphrine épidurale sur les concentrations plasmatiques de bupivacaine était aussi mesuré. Vingt patients avec une histoire etlou évidence a l’ECG d’ischémie myocardique requérant une chirurgie vasculaire periphérique ont été randomisés en deux groupes. Les patients furent surveillés avec un électrocardiogramme modifié en V5, une pression artérielle par oscillométrie et un cathéter dans I’artère pulmonaire. Apres des mesures hémodynamiques de contrôle, 12 ml de bupivacaine, 0,75 pour cent, ± épinéphrine, 5 μg · ml- 1 a été injecté sur cinq minutes dans I’espace épidural de L3- 4. Les mesures hémodynamiques ont été repétées à 15 et 45 minutes aprés l’injection. Aprés 15 minutes de l’injection épidurale, comparativement aux valeurs de contrôle, les patients ayant reçu de l’ épinéphrine en épidurale ont démontré une plus grande diminution significative dans la pression artérielle moyenne et la résistance vasculaire systémique, et une plus grande augmentation significative du débit cardiaque comparativement aux patients ayant reçu une injection d’épidurale de bupivacaine seule (79,3 ± 11,6 vs 94,6± 16,8 pour cent, 61,6 ± 9,0 vs 91,6± 19,2 pour cent, 130,8± 23 vs 105± 20,8 pour cent, respectivement). Ces différences n’étaient pas présentes 45 minutes après injection épidurale. La fréquence cardiaque n’était pas significativement differente entre les groupes en aucun temps. La présence de l’épinéphrine épidurale a réduit la concentration plasmatique maximale de bupivacaine de 0,86 ± 0,20, à 0,64 ± 0,33 μg · ml- 1 et a augmenté le temps afin d’atteindre cette concentration de 16,1 ± 11,2 à 33,7 ± 20,1 min.
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Salevsky, F.C., Whalley, D.G., Kalant, D. et al. Epidural epinephrine and the systemic circulation during peripheral vascular surgery. Can J Anaesth 37, 160–165 (1990). https://doi.org/10.1007/BF03005463
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DOI: https://doi.org/10.1007/BF03005463