Epidural Space For Thoracic Anesthesia Essay
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 period likely caused by a decrease in venous return, activating vagal reflex arcs (Hines & Marschall, 2012). Hines and Marschall mention that other explanations may include unopposed parasympathetic nervous system that is a direct result of the sympathectomy (2013). Theories behind the prevention include fluid volume loading, prior to epidural dosing, with 10-20 mL/kg. However, Butterworth, Mackey, and Wasnick report that in numerous studies this does not aid in the prevention of hypotension from bradydysrhythmia (2013). Fluid volume loading further places the patient at risk for developing acute lung injury (ALI) from excess fluid administration (Butterworth, Mackey, & Wasnick, 2013).