Abstract
The epidural administration of local anesthetics can provide anesthesia without the need for respiratory support or mechanical ventilation. Nevertheless, because of the additional effects of epidural anesthesia on motor function and sympathetic innervation, epidural anesthesia does affect lung function. These effects, i.e., a reduction in vital capacity (VC) and forced expiratory volume in 1 s (FEV1.0), are negligible under lumbar and low thoracic epidural anesthesia. Going higher up the vertebral column, these effects can increase up to 20% or 30% of baseline. However, compared with postoperative lung function following abdominal or thoracic surgery without epidural anesthesia, these effects are so small that the beneficial effects still lead to an improvement in postoperative lung function. These results can be explained by an improvement in pain therapy and diaphragmatic function, and by early extubation. In chronic obstructive pulmonary disease (COPD) patients, the use of thoracic epidural anesthesia has raised concerns about respiratory insufficiency due to motor blockade, and the risk of bronchial constriction due to sympathetic blockade. However, even in patients with severe asthma, thoracic epidural anesthesia leads to a decrease of about 10% in VC and FEV1.0 and no increase in bronchial reactivity. Overall, epidural administration of local anesthetics not only provides excellent anesthesia and analgesia but also improves postoperative outcome and reduces postoperative pulmonary complications compared with anesthesia and analgesia without epidural anesthesia.
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L Basse HH Raskov DH Jakobsen E Sonne P Billesbolle HW Hendel J Rosenberg H Kehlet (2002) ArticleTitleAccelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition Br J Surg 89 446–453 Occurrence Handle11952586 Occurrence Handle1:STN:280:DC%2BD383hs1KqsA%3D%3D Occurrence Handle10.1046/j.0007-1323.2001.02044.x
HM Loick C Schmidt H van Aken R Junker M Erren E Berendes N Rolf A Meissner C Schmid HH Scheld T Möllhoff (1999) ArticleTitleHigh thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting Anesth Analg 88 701–709 Occurrence Handle10195508 Occurrence Handle1:CAS:528:DyaK1MXislKrtLo%3D Occurrence Handle10.1097/00000539-199904000-00001
K Olausson H Magnusdottir L Lurje B Wennerblom H Emanuelsson S-E Ricksten (1997) ArticleTitleAnti-ischemic and anti-anginal effects of thoracic epidural anesthesia versus those of conventional medical therapy in the treatment of severe refractory unstable angina pectoris Circulation 96 2178–2182 Occurrence Handle9337187 Occurrence Handle1:CAS:528:DyaK2sXmvVKrsro%3D
H Rutberg E Hakanson B Anderberg L Jorfeldt J Martensson B Schildt (1984) ArticleTitleEffects of the extradural administration of morphine or bupivacaine on the endocrine response to upper abdominal surgery Br J Anaesth 56 233–238 Occurrence Handle6704272 Occurrence Handle1:STN:280:DyaL2c7lsVCjuw%3D%3D
FG Freund JJ Bonica RJ Ward TJ Akamatsu WF Kennedy (1967) ArticleTitleVentilatory reserve and level of motor block during high spinal and epidural anesthesia Anesthesiology 28 834–837 Occurrence Handle6035013 Occurrence Handle1:STN:280:DyaF2s3htFCntQ%3D%3D Occurrence Handle10.1097/00000542-196709000-00011
A Sundberg M Wattwil A Arvill (1986) ArticleTitleRespiratory effects of high thoracic epidural anaesthesia Acta Anaesthesiol Scand 30 215–217 Occurrence Handle3739578 Occurrence Handle1:STN:280:DyaL283pt1SjtQ%3D%3D
M Takasaki T Takahashi (1980) ArticleTitleRespiratory function during cervical and thoracic extradural analgesia in patients with normal lungs Br J Anaesth 52 1271–1275 Occurrence Handle7448102 Occurrence Handle1:STN:280:DyaL3M%2Fos1Ohsg%3D%3D
H Groeben B Schäfer G Pavlakovic MT Silvanus J Peters (2002) ArticleTitleLung function under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive pulmonary disease undergoing breast surgery Anesthesiology 96 536–541 Occurrence Handle11873024 Occurrence Handle1:CAS:528:DC%2BD38XisVGmt7g%3D Occurrence Handle10.1097/00000542-200203000-00005
AW Harrop-Griffiths A Ravalia DA Browne PN Robinson (1991) ArticleTitleRegional anaesthesia and cough effectiveness Anaesthesia 46 11–13 Occurrence Handle1878018 Occurrence Handle1:STN:280:DyaK3M7ksVSmtg%3D%3D
E Blair JB Hickam (1955) ArticleTitleThe effect of change in body position on lung volume and intrapulmonary gas mixing in normal subjects J Clin Invest 34 383–389 Occurrence Handle14354008 Occurrence Handle1:STN:280:DyaG2M%2FlsFGqtA%3D%3D Occurrence Handle10.1172/JCI103086
NB Scott T Mogensen D Bigler C Lund H Kehlet (1989) ArticleTitleContinuous thoracic extradural 0.5% bupivacaine with or without morphine: effect on quality of blockade, lung function and the surgical stress response Br J Anaesth 62 253–257 Occurrence Handle2649123 Occurrence Handle1:STN:280:DyaL1M7psVSitQ%3D%3D
T Hachenberg D Holst C Ebel B Pfeiffer H Thomas M Wendt G Hedenstierna (1997) ArticleTitleEffect of thoracic epidural anaesthesia on ventilation–perfusion distribution and intrathoracic blood volume before and after induction of general anaesthesia Acta Anaesthiol Scand 41 1142–1148 Occurrence Handle1:CAS:528:DyaK2sXntFCis7s%3D
WM Whaba DB Craig HF Don MR Becklake (1972) ArticleTitleThe cardio-respiratory effects of thoracic epidural anaesthesia Can Anaesth Soc J 19 8–19
WF Urmey (1993) ArticleTitlePulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume Reg Anesth 18 244–249 Occurrence Handle8398959 Occurrence Handle1:STN:280:DyaK2c%2FgtFOkug%3D%3D
P Michalek I David M Adamec L Janousek (2004) ArticleTitleCervical epidural anesthesia for combined neck and upper extremity procedure: a pilot study Anesth Analg 99 1833–1836 Occurrence Handle15562082 Occurrence Handle1:CAS:528:DC%2BD2cXpvV2rsL4%3D Occurrence Handle10.1213/01.ANE.0000137397.68815.7B
X Capdevila P Biboulet J Rubenovitch O Serre-Cousine P Peray J Deschodt F d'Athis (1998) ArticleTitleThe effects of cervical epidural anesthesia with bupivacaine on pulmonary function in conscious patients Anesth Analg 86 1033–1038 Occurrence Handle9585292 Occurrence Handle1:CAS:528:DyaK1cXjt12jsro%3D Occurrence Handle10.1097/00000539-199805000-00024
F Bonnet JP Dersosier F Pluskwa K Abhay A Gaillard (1990) ArticleTitleCervical epidural anesthesia for carotid artery surgery Can J Anaesth 37 353–358 Occurrence Handle2322972 Occurrence Handle1:STN:280:DyaK3c3htlOgsw%3D%3D
M Hakl P Sevcik J Pavlikova R Kraus (1998) ArticleTitleCervical epidural anesthesia for carotid artery surgery: new experience Int Monitor Reg Anaesth 10 79
MR Miller J Hankinson V Brusasco F Burgos R Casaburi A Coates R Crapo P Enright CPM vd Grinten P Gustafsson R Jensen DC Johnson N MacIntyre R McKay D Navajas OF Pedersen R Pellegrino G Viegi J Wanger (2005) ArticleTitleStandardisation of spirometry Eur Respir J 26 319–338 Occurrence Handle16055882 Occurrence Handle1:STN:280:DC%2BD2MzpsFOltw%3D%3D Occurrence Handle10.1183/09031936.05.00034805
B Debaene B Plaud MP Dilly F Donati (2003) ArticleTitleResidual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action Anesthesiology 98 1042–1048 Occurrence Handle12717123 Occurrence Handle1:CAS:528:DC%2BD3sXjt1alt7c%3D Occurrence Handle10.1097/00000542-200305000-00004
M Eikermann H Groeben B Bünten J Peters (2005) ArticleTitleFade of pulmonary function during residual neuromuscular blockade Chest 127 1703–1709 Occurrence Handle15888849 Occurrence Handle10.1378/chest.127.5.1703
M Eikermann M Blobner H Groeben C Rex T Grote M Neuhäuser M Beiderlinden J Peters (2006) ArticleTitlePostoperative upper airway obstruction after recovery of the train of four ratio of the adductor pollicis muscle from neuromuscular blockade Anesth Analg 102 937–942 Occurrence Handle16492855 Occurrence Handle10.1213/01.ane.0000195233.80166.14
A Tenling PO Joachimsson H Tyden G Hedenstierna (2000) ArticleTitleThoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery Acta Anaesthesiol Scand 44 1071–1076 Occurrence Handle11028725 Occurrence Handle1:STN:280:DC%2BD3cvnslemtw%3D%3D Occurrence Handle10.1034/j.1399-6576.2000.440906.x
DB Craig (1981) ArticleTitlePostoperative recovery of pulmonary function Anesth Analg 60 46–52 Occurrence Handle7006464 Occurrence Handle1:STN:280:DyaL3M7gslGlsw%3D%3D
G Simonneau A Vivien R Sartene F Kunstlinger K Samii Y Noviant P Duroux (1983) ArticleTitleDiaphragm dysfunction induced by upper abdominal surgery Am Rev Respir Dis 128 899–903 Occurrence Handle6638679 Occurrence Handle1:STN:280:DyaL2c%2FltVGhsA%3D%3D
JF Boylan J Katz BP Kavanagh JR Klinck DC Cheng WC DeMajo PM Walker KW Johnston AN Sandler (1998) ArticleTitleEpidural bupivacaine–morphine analgesia versus patient-controlled analgesia following aortic surgery: analgesic, respiratory, and myocardial effects Anesthesiology 89 585–593 Occurrence Handle9743393 Occurrence Handle1:CAS:528:DyaK1cXmt1Gkt7g%3D Occurrence Handle10.1097/00000542-199809000-00006
A Watson P Allen (1993) ArticleTitleInfluence of thoracic epidural analgesia on outcome after resection for esophageal cancer Surgery 115 429–432
WM Whaba HF Don DB Craig (1975) ArticleTitlePost-operative epidural analgesia: effects on lung volumes Can Anaesth Soc J 22 519–527
B Mankikian JP Cantineau M Bertrand E Kieffer R Sartene P Viars (1988) ArticleTitleImprovement of diaphragmatic function by a thoracic extradural block after abdominal surgery Anesthesiology 68 379–386 Occurrence Handle10.1097/00000542-198803000-00010
DM Polaner WR Kimball MD Fratacci JC Wain WM Zapol (1993) ArticleTitleThoracic epidural anesthesia increases diaphragmatic shortening after thoracotomy in the awake lamb Anesthesiology 79 808–816 Occurrence Handle8214761 Occurrence Handle1:STN:280:DyaK2c%2FivVWgsw%3D%3D
DO Warner MA Warner EL Ritman (1996) ArticleTitleHuman chest wall function during epidural anesthesia Anesthesiology 85 761–773 Occurrence Handle8873546 Occurrence Handle1:STN:280:DyaK2s%2FislCjtQ%3D%3D Occurrence Handle10.1097/00000542-199610000-00011
CL Wu SR Cohen JM Richman AJ Rowlingson GE Courpas K Cheung EE Lin SS Liu (2005) ArticleTitleEfficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids Anesthesiology 103 1079–1088 Occurrence Handle16249683 Occurrence Handle1:CAS:528:DC%2BD2MXhtFCru7vO Occurrence Handle10.1097/00000542-200511000-00023
JC Ballantyne DB Carr S deFerranti T Suarez J Lau TC Chalmers IF Angelillo F Mosteller (1998) ArticleTitleThe comparative effect of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Anesth Analg 86 598–612 Occurrence Handle9495424 Occurrence Handle1:CAS:528:DyaK1cXhvVygt70%3D Occurrence Handle10.1097/00000539-199803000-00032
A Rodgers N Walker S Schug A McKee H Kehlet A van Zundert D Sage M Futter G Saville T Clark S MacMahon (2000) ArticleTitleReduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials Br Med J 321 1–12 Occurrence Handle10.1136/bmj.321.7275.1493
R Stenseth L Bjella EM Berg O Christensen OW Levang SE Gisvold (1996) ArticleTitleEffects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery Eur J Cardiothorac Surg 10 859–865 Occurrence Handle8911839 Occurrence Handle1:STN:280:DyaK2s%2FmvVGkuw%3D%3D Occurrence Handle10.1016/S1010-7940(96)80311-3
MC Pastor MJ Sanchez MA Casas J Mateu ML Bataller (2003) ArticleTitleThoracic epidural analgesia in coronary artery bypass graft surgery: seven years' experience J Cardiothorac Vasc Anesth 17 154–159 Occurrence Handle12698394 Occurrence Handle10.1053/jcan.2003.39
DJ Turfrey AA Ray NP Sutcliffe P Ramayya GNC Kenny NB Scott (1997) ArticleTitleThoracic epidural anaesthesia for coronary artery bypass graft surgery Anaesthesia 52 1090–1113 Occurrence Handle9404174 Occurrence Handle1:STN:280:DyaK1c%2Fmsl2rtw%3D%3D Occurrence Handle10.1111/j.1365-2044.1997.260-az0397.x
MC Priestley L Cope R Halliwell P Gibson RB Chard M Skinner PL Klineberg (2002) ArticleTitleThoracic epidural anesthesia for cardiac surgery: the effects on tracheal intubation time and length of hospital stay Anesth Analg 94 275–282 Occurrence Handle11812684 Occurrence Handle1:CAS:528:DC%2BD38Xhtlehsbs%3D Occurrence Handle10.1097/00000539-200202000-00009
J Paiste RJ Bjerke JP Williams MA Zenati GE Nagy (2001) ArticleTitleMinimally invasive direct coronary artery bypass surgery under high thoracic epidural Anesth Analg 93 1486–1488 Occurrence Handle11726428 Occurrence Handle1:STN:280:DC%2BD3MnotVWiug%3D%3D Occurrence Handle10.1097/00000539-200112000-00028
P Kessler G Neidhart DH Bremerich T Aybek S Dogan V Lischke C Byhan (2002) ArticleTitleHigh thoracic epidural anesthesia for coronary artery bypass grafting using two different surgical approaches in conscious patients Anesth Analg 95 791–797 Occurrence Handle12351247 Occurrence Handle1:CAS:528:DC%2BD38XosFGms7Y%3D Occurrence Handle10.1097/00000539-200210000-00002
Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK (1998) Coronary artery bypass grafting in patients with COPD. 113:878–882
WJ Fawcett RE Edwards AC Quinn IA MacDonald GM Hall (1997) ArticleTitleThoracic epidural analgesia started after cardiopulmonary bypass Anaesthesia 52 294–299 Occurrence Handle9135178 Occurrence Handle1:STN:280:DyaK2s3otVyksg%3D%3D Occurrence Handle10.1111/j.1365-2044.1997.80-az0088.x
MA Chaney (2006) ArticleTitleIntrathecal and epidural anesthesia and analgesia for cardiac surgery Anesth Analg 102 45–64 Occurrence Handle16368803 Occurrence Handle1:CAS:528:DC%2BD2MXhtlSqurbN Occurrence Handle10.1213/01.ane.0000183650.16038.f6
RA Pauwels AS Buist PM Calverley CR Jenkins SS Hurd (2001) ArticleTitleGlobal strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary Am J Respir Crit Care Med 163 1256–1276 Occurrence Handle11316667 Occurrence Handle1:STN:280:DC%2BD3MzisFGqtw%3D%3D
FW Cheney KL Posner RA Caplan (1991) ArticleTitleAdverse respiratory events infrequently leading to malpractice suits. A closed claims analysis Anesthesiology 75 932–939 Occurrence Handle1741513 Occurrence Handle1:STN:280:DyaK38%2FnsVKhsw%3D%3D Occurrence Handle10.1097/00000542-199112000-00002
SM Shnider EM Papper (1961) ArticleTitleAnesthesia for the asthmatic patient Anesthesiology 22 886–892 Occurrence Handle13912204 Occurrence Handle1:STN:280:DyaF387gtlOqtA%3D%3D Occurrence Handle10.1097/00000542-196101000-00018
S Tarhan EA Moffitt AD Sessler WW Douglas WF Taylor (1973) ArticleTitleRisk of anesthesia and surgery in patients with chronic bronchitis and chronic obstructive pulmonary disease Surgery 74 720–726 Occurrence Handle4742756 Occurrence Handle1:STN:280:DyaE2c%2FgsFGlsA%3D%3D
JA Flores T Nishibe M Koyama T Imai F Kudo K Miyazaki K Yasuda (2001) ArticleTitleCombined spinal and epidural anesthesia for abdominal aortic aneurysm surgery in patients with severe chronic pulmonary obstructive disease Int Angiol 21 218–221
H Groeben A Schwalen S Irsfeld J Tarnow P Lipfert HB Hopf (1994) ArticleTitleHigh thoracic epidural anesthesia does not alter airway resistance and attenuates the response to an inhalational provocation test in patients with bronchial hyperreactivity Anesthesiology 81 868–874 Occurrence Handle7943838 Occurrence Handle1:STN:280:DyaK2M%2FjtVCguw%3D%3D Occurrence Handle10.1097/00000542-199410000-00014
HA Boushey MJ Holtzmann JR Sheller JA Nadel (1980) ArticleTitleBronchial hyperreactivity Am Rev Respir Dis 121 389–413 Occurrence Handle6987924 Occurrence Handle1:CAS:528:DyaL3cXhvFGlu7g%3D
AJ Woolcock JK Peat CM Salome K Yan SD Anderson RE Schoeffel G McCowage T Killalea (1987) ArticleTitlePrevalence of bronchial hyperresponsiveness and asthma in a rural adult population Thorax 42 361–368 Occurrence Handle3660290 Occurrence Handle1:STN:280:DyaL1c%2FhvVGrsA%3D%3D Occurrence Handle10.1136/thx.42.5.361
JK Peat CM Salome AJ Woolcock (1990) ArticleTitleLongitudinal changes in atopy during a 4-year period: relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren J Allergy Clin Immunol 85 65–74 Occurrence Handle2299108 Occurrence Handle1:STN:280:DyaK3c7jtFGhsQ%3D%3D Occurrence Handle10.1016/0091-6749(90)90223-Q
DW Empey LA Laitinen L Jacobs WM Gold JA Nadel (1976) ArticleTitleMechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection Am Rev Respir Dis 113 131–139 Occurrence Handle1247226 Occurrence Handle1:STN:280:DyaE287htVSktg%3D%3D
JI Du Troit AJ Woolcock CM Salome R Sundrum JL Black (1986) ArticleTitleCharacteristics of bronchial hyperresponsiveness in smokers with chronic airflow limitation Am Rev Respir Dis 134 498–501
DO Warner MA Warner KP Offord DR Schroeder P Maxson PD Scanlon (1999) ArticleTitleAirway obstruction and perioperative complications in smokers undergoing abdominal surgery Anesthesiology 90 372–379 Occurrence Handle9952139 Occurrence Handle1:STN:280:DyaK1M7jsFKisg%3D%3D Occurrence Handle10.1097/00000542-199902000-00007
InstitutionalAuthorNameAmerican Thoracic Society (ATS) (1987) ArticleTitleStandards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma Am Rev Respir Dis 136 225–244
JW Ramsdell FJ Nachtwey KM Moser (1982) ArticleTitleBronchial hyperreactivity in chronic obstructive bronchitis Am Rev Respir Dis 126 829–832 Occurrence Handle7149448 Occurrence Handle1:STN:280:DyaL3s%2Fnt1yrtg%3D%3D
JS Milledge JF Nunn (1975) ArticleTitleCriteria of fitness for anaesthesia in patients with chronic obstructive lung disease Br Med J 3 670–673 Occurrence Handle240480 Occurrence Handle1:STN:280:DyaE28%2FhvF2qtg%3D%3D
DO Warner MA Warner RD Barnes KP Offord DR Schroeder DT Gray JW Yunginger (1996) ArticleTitlePerioperative respiratory complications in patients with asthma Anesthesiology 85 460–467 Occurrence Handle8853074 Occurrence Handle1:STN:280:DyaK2s%2FgsFOktw%3D%3D Occurrence Handle10.1097/00000542-199609000-00003
MM Cohen CB Cameron (1991) ArticleTitleShould you cancel the operation when a child has an upper respiratory tract infection? Anesth Analg 72 282–288 Occurrence Handle1994755 Occurrence Handle1:STN:280:DyaK3M7jsF2muw%3D%3D Occurrence Handle10.1213/00000539-199103000-00002
H Groeben M Schlicht S Stieglitz G Pavlakovic J Peters (2002) ArticleTitleBoth local anesthetics and salbutamol pretreatment affect reflex bronchoconstriction in volunteers with asthma undergoing awake fiberoptic intubation Anesthesiology 97 1445–1450 Occurrence Handle12459670 Occurrence Handle1:CAS:528:DC%2BD38XptFGmsL4%3D Occurrence Handle10.1097/00000542-200212000-00016
PV Dicpinigaitis AM Spungen WA Bauman A Absgarten PL Almenhoff (1994) ArticleTitleBronchial hyperresponsiveness after cervical spinal cord injury Chest 105 1073–1076 Occurrence Handle8162727 Occurrence Handle1:STN:280:DyaK2c3hsFentg%3D%3D
RV DeLuca DR Grimm M Lesser WA Bauman PL Almenhoff (1999) ArticleTitleEffects of a ß2-agonist on airway hyperreactivity in subjects with cervical spinal cord injury Chest 115 1533–1538 Occurrence Handle10378545 Occurrence Handle1:CAS:528:DyaK1MXktFGitLg%3D Occurrence Handle10.1378/chest.115.6.1533
DH Bryant (1992) ArticleTitleDrug-induced pulmonary disease Med J Aust 156 802–805 Occurrence Handle1352846 Occurrence Handle1:STN:280:DyaK38zjsVWqug%3D%3D
JD Wallin (1985) ArticleTitleBeta-adrenergic blockers in the hypertensive asthmatic patient Chest 88 801–802 Occurrence Handle2866069 Occurrence Handle1:STN:280:DyaL28%2FlsFSjtA%3D%3D
JD Tobias RA Sauder CA Hirshman (1990) ArticleTitlePulmonary reactivity to metacholine during beta-adrenergic blockade: propranolol versus esmolol Anesthesiology 73 132–136 Occurrence Handle1972872 Occurrence Handle1:CAS:528:DyaK3cXltV2jtbs%3D Occurrence Handle10.1097/00000542-199007000-00019
MR Gold GW Dec D Cocca-Spofford BT Thompson (1991) ArticleTitleEsmolol and ventilatory function in patients with COPD Chest 100 1215–1218 Occurrence Handle1682112 Occurrence Handle1:STN:280:DyaK38%2Fjs1KjtQ%3D%3D
PR Bromage (1978) Status asthmaticus PR Bromage (Eds) Epidural analgesia WB Saunders Philadelphia 638–642
S Shono K Higa I Harasawa H Sugano K Dan (1999) ArticleTitleDisappearance of wheezing during epidural lidocaine anesthesia in a patient with bronchial asthma Reg Anesth Pain Med 24 463–466 Occurrence Handle10499760 Occurrence Handle1:STN:280:DyaK1MvivVWjtA%3D%3D Occurrence Handle10.1016/S1098-7339(99)90015-9
WS Beattie NH Badner P Choi (2001) ArticleTitleEpidural analgesia reduces postoperative myocardial infarction: a meta-analysis Anesth Analg 93 853–858 Occurrence Handle11574345 Occurrence Handle1:STN:280:DC%2BD3Mrisl2mtQ%3D%3D Occurrence Handle10.1097/00000539-200110000-00010
TJ Gal (1994) ArticleTitleBronchial hyperresponsiveness and anesthesia: physiologic and therapeutic perspectives Anesth Analg 78 559–57337 Occurrence Handle8109778 Occurrence Handle1:STN:280:DyaK2c7lt1ylsw%3D%3D Occurrence Handle10.1213/00000539-199403000-00025
CA Hirshman (1991) ArticleTitlePerioperative management of the asthmatic patient Can J Anaesth 38 R26–R32 Occurrence Handle2060072 Occurrence Handle1:STN:280:DyaK3M3osValuw%3D%3D Occurrence Handle10.1007/BF03008432
EM Gruber EM Tschernko M Kritzinger E Deviatko W Wisser D Zurakowski W Haider (2001) ArticleTitleThe effects of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics I. Patients with severe chronic obstructive pulmonary disease Anesth Analg 92 1015–1019 Occurrence Handle11273942 Occurrence Handle1:CAS:528:DC%2BD3MXislylurk%3D Occurrence Handle10.1097/00000539-200104000-00039
JF Butterworth GR Strichartz (1990) ArticleTitleMolecular mechanisms of local anesthesia: a review Anesthesiology 72 711–734 Occurrence Handle2157353 Occurrence Handle1:CAS:528:DyaK3cXhvFWht7g%3D Occurrence Handle10.1097/00000542-199004000-00022
T Kai J Nishimura S Kobayashi S Takahashi J Yoshitake H Kanaide (1993) ArticleTitleEffects of lidocaine on intracellular Ca2+ and tension in airway smooth muscle Anesthesiology 1993 78 954–965 Occurrence Handle1:CAS:528:DyaK3sXks1aru70%3D Occurrence Handle10.1097/00000542-199305000-00021
JE Steinhaus L Gaskin (1963) ArticleTitleA study of intravenous lidocaine as a suppressant of cough reflex Anesthesiology 24 285–290 Occurrence Handle13983769 Occurrence Handle1:STN:280:DyaF387nsFKjsg%3D%3D
H Groeben A Schwalen S Irsfeld S Stieglitz P Lipfert HB Hopf (1996) ArticleTitleIntravenous lidocaine and bupivacaine dose-dependently attenuate bronchial hyperreactivity in awake volunteers Anesthesiology 84 533–539 Occurrence Handle8659780 Occurrence Handle1:CAS:528:DyaK28XitlKrs7s%3D Occurrence Handle10.1097/00000542-199603000-00007
H Yukioka M Hayashi T Terai M Fuijmori (1993) ArticleTitleIntravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients Anesth Analg 77 309–312 Occurrence Handle8346830 Occurrence Handle1:STN:280:DyaK3szkvV2msA%3D%3D Occurrence Handle10.1213/00000539-199377020-00016
H Groeben MT Silvanus M Beste J Peters (1998) ArticleTitleCombined intravenous lidocaine and inhaled salbutamol protect against bronchial hyperreactivity more effectively than lidocaine or salbutamol alone Anesthesiology 89 862–868 Occurrence Handle9778003 Occurrence Handle1:CAS:528:DyaK1cXntVegsL0%3D Occurrence Handle10.1097/00000542-199810000-00010
F Yanagidate S Dohi (2003) ArticleTitleTwo episodes of bronchospasm during anaesthesia in asthmatic patients Eur J Anaesthe 20 579–580 Occurrence Handle1:STN:280:DC%2BD3szlt1eiuw%3D%3D Occurrence Handle10.1017/S0265021503230921
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Groeben, H. Epidural anesthesia and pulmonary function. J Anesth 20, 290–299 (2006). https://doi.org/10.1007/s00540-006-0425-6
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DOI: https://doi.org/10.1007/s00540-006-0425-6