Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters
Background Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3–T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neura...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2013-07, Vol.57 (6), p.767-775 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | WINK, J. WOLTERBEEK, R. AARTS, L. P. H. J. KOSTER, S. C. E. VERSTEEGH, M. I. M. VEERING, B. T. H. |
| description | Background
Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3–T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied.
Methods
Thirty‐five lung surgery patients were included in three age groups. Thirty‐one patients received an epidural catheter at the T3–T4 interspace followed by an injection of 8‐ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV).
Results
There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P |
| doi_str_mv | 10.1111/aas.12087 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1419365788</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2989865241</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4247-749af0bfccb7da37a2ded175e8c3a12d7691864a033450790bea6403f08b5d263</originalsourceid><addsrcrecordid>eNqF0U1v1DAQBmALgehSOPAHkCUucEjrbyfcVhUUpBUc2mqP1sSe0LTZONgJ0H-P2217QEL4Yll6ZjSel5DXnB3xco4B8hEXrLZPyIrLpqmMtuYpWTHGeKW5FQfkRc5X5SlV0zwnB0IqwbW2KxIupgkTnS9jAt97ilMflgQDhREwz5eYe_hAsevQz5nGjsJ3pHGkI96pdoj-GgIWHqiHFPr4E7JfBkh0ggQ7nDHll-RZB0PGV_f3Ibn49PH85HO1-Xb65WS9qbwSylZWNdCxtvO-tQGkBREwcKux9hK4CNY0vDYKmJRKM9uwFsEoJjtWtzoIIw_Ju33fKcUfSxnf7frscRhgxLhkxxVvZNlNXf-fSlOgrqUo9O1f9CouaSwfuVVli7Uxtqj3e-VTzDlh56bU7yDdOM7cbUqupOTuUir2zX3Hpd1heJQPsRRwvAe_-gFv_t3JrddnDy2rfUWfZ_z9WAHp2pXhrHbbr6fu_Gy73ahaOib_AHuEqfk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1365578667</pqid></control><display><type>article</type><title>Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>WINK, J. ; WOLTERBEEK, R. ; AARTS, L. P. H. J. ; KOSTER, S. C. E. ; VERSTEEGH, M. I. M. ; VEERING, B. T. H.</creator><creatorcontrib>WINK, J. ; WOLTERBEEK, R. ; AARTS, L. P. H. J. ; KOSTER, S. C. E. ; VERSTEEGH, M. I. M. ; VEERING, B. T. H.</creatorcontrib><description>Background
Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3–T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied.
Methods
Thirty‐five lung surgery patients were included in three age groups. Thirty‐one patients received an epidural catheter at the T3–T4 interspace followed by an injection of 8‐ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV).
Results
There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P < 0.001), mean arterial pressure (16.1 ± 15.6, P < 0.001), CI (0.55 ± 0.49, P < 0.001) and SV (9.6 ± 14.6, P = 0.001) decreased after TEA for the total group. Maximal reduction in heart rate after TEA was more extensive in the young age group compared with the other age groups. There was no effect of age on other cardiovascular parameters.
Conclusion
We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.12087</identifier><identifier>PMID: 23421557</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aging - physiology ; Amides - administration & dosage ; Amides - pharmacokinetics ; Amides - pharmacology ; Anesthesia, Epidural - methods ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - pharmacokinetics ; Anesthetics, Local - pharmacology ; Blood Pressure - drug effects ; Cardiac Output - drug effects ; Diffusion ; Heart Rate - drug effects ; Humans ; Middle Aged ; Nerve Block ; Neural Conduction - drug effects ; Pleurodesis ; Stroke Volume - drug effects ; Thoracic Surgery, Video-Assisted ; Thoracic Vertebrae ; Thoracotomy ; Tissue Distribution ; Young Adult</subject><ispartof>Acta anaesthesiologica Scandinavica, 2013-07, Vol.57 (6), p.767-775</ispartof><rights>2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2013 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4247-749af0bfccb7da37a2ded175e8c3a12d7691864a033450790bea6403f08b5d263</citedby><cites>FETCH-LOGICAL-c4247-749af0bfccb7da37a2ded175e8c3a12d7691864a033450790bea6403f08b5d263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faas.12087$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faas.12087$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23421557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>WINK, J.</creatorcontrib><creatorcontrib>WOLTERBEEK, R.</creatorcontrib><creatorcontrib>AARTS, L. P. H. J.</creatorcontrib><creatorcontrib>KOSTER, S. C. E.</creatorcontrib><creatorcontrib>VERSTEEGH, M. I. M.</creatorcontrib><creatorcontrib>VEERING, B. T. H.</creatorcontrib><title>Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3–T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied.
Methods
Thirty‐five lung surgery patients were included in three age groups. Thirty‐one patients received an epidural catheter at the T3–T4 interspace followed by an injection of 8‐ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV).
Results
There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P < 0.001), mean arterial pressure (16.1 ± 15.6, P < 0.001), CI (0.55 ± 0.49, P < 0.001) and SV (9.6 ± 14.6, P = 0.001) decreased after TEA for the total group. Maximal reduction in heart rate after TEA was more extensive in the young age group compared with the other age groups. There was no effect of age on other cardiovascular parameters.
Conclusion
We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aging - physiology</subject><subject>Amides - administration & dosage</subject><subject>Amides - pharmacokinetics</subject><subject>Amides - pharmacology</subject><subject>Anesthesia, Epidural - methods</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - pharmacokinetics</subject><subject>Anesthetics, Local - pharmacology</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiac Output - drug effects</subject><subject>Diffusion</subject><subject>Heart Rate - drug effects</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Nerve Block</subject><subject>Neural Conduction - drug effects</subject><subject>Pleurodesis</subject><subject>Stroke Volume - drug effects</subject><subject>Thoracic Surgery, Video-Assisted</subject><subject>Thoracic Vertebrae</subject><subject>Thoracotomy</subject><subject>Tissue Distribution</subject><subject>Young Adult</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0U1v1DAQBmALgehSOPAHkCUucEjrbyfcVhUUpBUc2mqP1sSe0LTZONgJ0H-P2217QEL4Yll6ZjSel5DXnB3xco4B8hEXrLZPyIrLpqmMtuYpWTHGeKW5FQfkRc5X5SlV0zwnB0IqwbW2KxIupgkTnS9jAt97ilMflgQDhREwz5eYe_hAsevQz5nGjsJ3pHGkI96pdoj-GgIWHqiHFPr4E7JfBkh0ggQ7nDHll-RZB0PGV_f3Ibn49PH85HO1-Xb65WS9qbwSylZWNdCxtvO-tQGkBREwcKux9hK4CNY0vDYKmJRKM9uwFsEoJjtWtzoIIw_Ju33fKcUfSxnf7frscRhgxLhkxxVvZNlNXf-fSlOgrqUo9O1f9CouaSwfuVVli7Uxtqj3e-VTzDlh56bU7yDdOM7cbUqupOTuUir2zX3Hpd1heJQPsRRwvAe_-gFv_t3JrddnDy2rfUWfZ_z9WAHp2pXhrHbbr6fu_Gy73ahaOib_AHuEqfk</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>WINK, J.</creator><creator>WOLTERBEEK, R.</creator><creator>AARTS, L. P. H. J.</creator><creator>KOSTER, S. C. E.</creator><creator>VERSTEEGH, M. I. M.</creator><creator>VEERING, B. T. H.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters</title><author>WINK, J. ; WOLTERBEEK, R. ; AARTS, L. P. H. J. ; KOSTER, S. C. E. ; VERSTEEGH, M. I. M. ; VEERING, B. T. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4247-749af0bfccb7da37a2ded175e8c3a12d7691864a033450790bea6403f08b5d263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aging - physiology</topic><topic>Amides - administration & dosage</topic><topic>Amides - pharmacokinetics</topic><topic>Amides - pharmacology</topic><topic>Anesthesia, Epidural - methods</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - pharmacokinetics</topic><topic>Anesthetics, Local - pharmacology</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiac Output - drug effects</topic><topic>Diffusion</topic><topic>Heart Rate - drug effects</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Nerve Block</topic><topic>Neural Conduction - drug effects</topic><topic>Pleurodesis</topic><topic>Stroke Volume - drug effects</topic><topic>Thoracic Surgery, Video-Assisted</topic><topic>Thoracic Vertebrae</topic><topic>Thoracotomy</topic><topic>Tissue Distribution</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WINK, J.</creatorcontrib><creatorcontrib>WOLTERBEEK, R.</creatorcontrib><creatorcontrib>AARTS, L. P. H. J.</creatorcontrib><creatorcontrib>KOSTER, S. C. E.</creatorcontrib><creatorcontrib>VERSTEEGH, M. I. M.</creatorcontrib><creatorcontrib>VEERING, B. T. H.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WINK, J.</au><au>WOLTERBEEK, R.</au><au>AARTS, L. P. H. J.</au><au>KOSTER, S. C. E.</au><au>VERSTEEGH, M. I. M.</au><au>VEERING, B. T. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2013-07</date><risdate>2013</risdate><volume>57</volume><issue>6</issue><spage>767</spage><epage>775</epage><pages>767-775</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background
Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3–T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied.
Methods
Thirty‐five lung surgery patients were included in three age groups. Thirty‐one patients received an epidural catheter at the T3–T4 interspace followed by an injection of 8‐ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV).
Results
There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P < 0.001), mean arterial pressure (16.1 ± 15.6, P < 0.001), CI (0.55 ± 0.49, P < 0.001) and SV (9.6 ± 14.6, P = 0.001) decreased after TEA for the total group. Maximal reduction in heart rate after TEA was more extensive in the young age group compared with the other age groups. There was no effect of age on other cardiovascular parameters.
Conclusion
We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>23421557</pmid><doi>10.1111/aas.12087</doi><tpages>9</tpages></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2013-07, Vol.57 (6), p.767-775 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Adult Aged Aged, 80 and over Aging - physiology Amides - administration & dosage Amides - pharmacokinetics Amides - pharmacology Anesthesia, Epidural - methods Anesthetics, Local - administration & dosage Anesthetics, Local - pharmacokinetics Anesthetics, Local - pharmacology Blood Pressure - drug effects Cardiac Output - drug effects Diffusion Heart Rate - drug effects Humans Middle Aged Nerve Block Neural Conduction - drug effects Pleurodesis Stroke Volume - drug effects Thoracic Surgery, Video-Assisted Thoracic Vertebrae Thoracotomy Tissue Distribution Young Adult |
| title | Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters |
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