Effect of thoracic epidural anesthesia and PCEA on blood coagulation and hemorheology in patients undergoing major thoracic surgery
- VernacularTitle:硬膜外阻滞对胸科手术患者血液流变学及凝血功能的影响
- Author:
Xiaoyun CHEN
;
Xinmin WU
- Publication Type:Journal Article
- Keywords:
Anesthesia,epidural;
Hemorheology;
Blood coagulation;
Thoracic surgery
- From:
Chinese Journal of Anesthesiology
1994;0(06):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the influence of epidural block on blood coagulation and rhedogy in patients undergoing esophagectomy or lobectomy. Methods Twenty-two ASA Ⅰ-Ⅱ patients (14 male, 8 female) aged 40-65 yr undergoing esophagectomy or lobectomy were randomized to receive either combined general-epidural anesthesia (GEA group , n = 11) or general anesthesia (GA group, n = 11). The patients were premedicated with intramuscular pethidine 50 mg, promethazine 25 mg and scopolamine 0.3 mg. In GEA group epidural catheter was placed at T9-10 interspace before general anesthesia. A test dose of 4 ml 2% lidocaine was given. When correct positioning of the epidural catheter was confirmed, general anesthesia was induced with propofol 1.5-2.0 mg? kg-1 , fentanyl 2?g?kg-1 and rocuronium 0.6 mg? kg-1 , after placement of double- lumen endobronchial tube the patients were mechanically ventilated (VT 10 ml?kg-1 , RR 12 bpm, I: E = 1:2). Anesthesia was maintained with isoflurane inhalation and intermittent i. v. boluses of vecuronium. A mixture of 2 % lidocaine and 0.33% dicaine (1:1) was continuously infused at a rate of 4-6 ml?h-1 during operation. After operation PCEA was commenced with 0.12% ropivacaine and morphine 80 ?g?ml-1 (background infusion 4 ml?h-1 , bolus dose 2 ml, lockout interval 6 min) . In GA group the patients received the same general anesthesia technique. Postoperatively the patients were placed on PCIA with morphine 0.5 mg?ml-1 (background infusion 1 ml?h-1 , bolus dose 2 ml, lockout interval 6 min) Pain intensity was measured using VAS (0-10). Blood samples were taken before induction of anesthesia (T0, baseline), 1 and 3 h after skin incision (T1 , T2 ) and on the morning of 1st and 3rd postoperative day (T3 , T4 ) . Blood samples were tested immediately in a thromboelastograph (TEG) coagulation analyzer. Usual clotting tests (PT, APTT, platelet count, Hb, Hct), fibrinolysis tests (t-PA, PAI-A) and rheology tests were performed at the same time. Results PT and APTT were significantly prolonged during and after operation (T2,T3 ) as compared with the baseline values in both groups (P
