Epidural Anesthesia

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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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Patients receiving a thoracotomy often have an extensive list of associated co-morbidities that need to be taken into consideration when planning an anesthetic. In addition, the surgical procedure results in changes to hemodynamics due to patient positioning, one-lung ventilation (OLV), increases in pulmonary vascular resistance (PVR), and surgical manipulation of the lung parenchyma (Pintaric et al., 2011). One of the anesthetic goals is to anesthetize the patient in a way to handle the stress of the procedure in addition to optimizing them for recovery. Excessive intravenous fluid intake has been shown to increase a patient’s risk of postoperative ALI and needs to be administered judiciously (Butterworth, Mackey, & Wasnick, 2013). This may be a challenge if a thoracic epidural is placed, resulting in vasodilation leading to fluid resuscitation and the use of vasopressors to maintain …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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