Stenseth R, Berg E M, Bjella L, Christensen O, Levang O W, Gisvold S E
Department of Anaesthesiology, Regional Hospital, University of Trondheim, Norway.
Anesth Analg. 1993 Sep;77(3):463-8. doi: 10.1213/00000539-199309000-00008.
Thoracic epidural analgesia combined with chronic beta-adrenergic blocker medication may cause cardiac depression. We investigated the cardiovascular and myocardial metabolic effects of a T1-T12 epidural block in 18 patients (age < 65 yr, ejection fraction > 0.5), receiving chronic beta-adrenergic blocker medication and scheduled for aortocoronary bypass surgery. After randomization into a light or deeper general anesthetic group, the cardiovascular and myocardial metabolic effects of a subsequent general anesthesia induction were investigated. Thoracic epidural analgesia induced a moderate decrease in mean arterial pressure, coronary perfusion pressure, free fatty acids, and myocardial consumption of free fatty acids. General anesthesia with thiopental (2-4 mg/kg) and a low fentanyl dose (5 micrograms/kg) increased heart rate, coronary perfusion pressure, and coronary vascular resistance, whereas mean pulmonary arterial pressure and pulmonary capillary wedge pressure decreased. After thiopental (2-4 mg/kg) and a high fentanyl dose (30 micrograms/kg), mean arterial pressure and left ventricular stroke work index decreased. We conclude that a T1-T12 epidural block in well sedated, beta-adrenergic blocked patients does not induce clinically significant cardiovascular effects. Induction of general anesthesia was well tolerated, but the light general anesthetic could not prevent an increase in heart rate and coronary vascular resistance, whereas the deeper anesthetic induced slight myocardial depression. No effect on the atrioventricular conduction, as measured by the PQ-time, was noted.
胸段硬膜外镇痛联合慢性β-肾上腺素能阻滞剂用药可能会导致心脏抑制。我们研究了18例（年龄<65岁，射血分数>0.5）接受慢性β-肾上腺素能阻滞剂用药且计划行主动脉冠状动脉搭桥手术的患者，T1-T12硬膜外阻滞对心血管和心肌代谢的影响。在随机分为浅全麻组或深全麻组后，研究随后全身麻醉诱导的心血管和心肌代谢影响。胸段硬膜外镇痛导致平均动脉压、冠状动脉灌注压、游离脂肪酸及游离脂肪酸心肌消耗量中度降低。硫喷妥钠（2-4mg/kg）和低剂量芬太尼（5μg/kg）全麻使心率、冠状动脉灌注压及冠状动脉血管阻力增加，而平均肺动脉压和肺毛细血管楔压降低。硫喷妥钠（2-4mg/kg）和高剂量芬太尼（30μg/kg）后，平均动脉压和左心室每搏功指数降低。我们得出结论，在充分镇静、β-肾上腺素能阻滞剂用药的患者中，T1-T12硬膜外阻滞不会诱发具有临床意义的心血管效应。全身麻醉诱导耐受性良好，但浅全麻不能预防心率和冠状动脉血管阻力增加，而深全麻会诱发轻微的心肌抑制。未观察到通过PQ间期测量的对房室传导的影响。
