Anesthesia Case Study

1490 Words 6 Pages
1941 Rees and Abajian utilized the epidural space for thoracic anesthesia. The progression of epidural anesthesia finally peaked with continuous infusion of an anesthetic in thoracic surgeries in 1953 (Blas, 1996).
Hemodynamic complications associated with epidural anesthesia include the possible development of severe bradycardia or asystole. According to Hines and Marschall, this is most likely to occur an hour after the epidural is used for injection (2012). Approximately half of the patients that develop a bradydysrhythmia experience shortness of breath, nausea and vomiting, restlessness, light-headedness, and a deterioration in mental status prior to the onset of a dysrhythmia. This side effect can even persist into the postoperative
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Statistically, no difference was noted in the stroke volume (SV), heart rate (HR), and mean arterial pressure (MAP) throughout the case. The oxygen delivery index (DO2I) was measured and a goal of 500 mL/min per squared meter high was selected. Significantly more colloids and vasopressors were used in the TEA group than the PVB group to maintain the DO2I. The authors concluded that utilization of a PVB provided greater cardiovascular stability through a reduction in administration of colloids and vasopressors to maintain predetermined hemodynamic parameters. The increase in hemodynamic stability is likely due to the lack of sympathetic blockade from a PVB (Pintaric et al., …show more content…
Casalino et al, studied the effects of thoracic epidural in cardiac surgery (2006). The researchers concluded that HTEA provides improved analgesia and postoperative respiratory function and a reduced response to surgical stimuli and myocardial oxygen demand. Despite the findings, epidural anesthesia in cardiac surgery is not considered the standard of care. Major complication associated HTEA include neurological injuries secondary to neuraxial hematomas and hypotension secondary to sympatholysis. Interestingly, the authors discovered a correlation between the female sex and hypotension. Despite the general consensus of neurological injury, this retrospective study of 144 patients resulted in no such event. However, another concern of HTEA is the accidental injection or migration of the catheter into the intrathecal space. Of the 144 patients, two resulted in this complication leading to immediate endotracheal intubation with prolonged ventilation and cancellation of the surgical procedure (Casalino et al,

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