Korean J Anesthesiol.  1999 May;36(5):808-817. 10.4097/kjae.1999.36.5.808.

Comparision of Hemodynamic Changes in Patients Undertaking Hysterectomies under Genernal and Epidural Anesthesia

• You HM
• Jeon JK
• Kim AR

• KMID: 2240070
• DOI: http://doi.org/10.4097/kjae.1999.36.5.808

Abstract

BACKGROUND: The purpose of the study was to evaluate the effect of postural change on hemodynamics using thoracic eletrical bioimpedance (TEB) device during general anesthesia with enflurane-N2O-O2 and lumbar epidural anesthesia. The TEB device is safe, reliable and non-invasive way to measure hemodynmic values continuously.
METHODS
General anesthesia (twenty patients) was induced by administration of pentotal sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously, and was maintained with 1 vol% of enflurane, N2O-O2 (2 l/min-2 l/min) and vecuronium 0.1 mg/kg. Epidural anesthesia (twenty patients) was performed at the level of L3-4 epidural space using 20 ml of 2% xylocaine mixed with epinephrine (5 microgram/ml). Hemodynamic changes were measured before induction, 1 and 5 minutes after intubation or epidural injection, 1, 5, 10, 20, 30 minutes after head- down tilt and 1, 5, 10 minutes after returning to the supine position.
RESULTS
HR and LVSWI were minimaly affected in group E with epidural anesthesia compared to group G with general anesthesia. BP (SBP, DBP, MAP) and SVRI were remarkably increased in group G compared to group E. BP and SVRI showed rapid increse 1 minutes after head-down tilt in group G (p<0.01) and decreased gradually thereafter. SI and CI were decreased significantly in group G compared to group E (p<0.001). SI was unchanged but CI was decreasd significantly after head-down tilt in group E (p<0.05). EDI and ACI showed lower values decreased in general significantly in group G compared to group E (p<0.05).
CONCLUSIONS
All hemodynamic changes were more predictable, gradual, less variable, and stable in the group with epidural anesthesia compared to the group with general anesthesia for hysterectomy.

Keyword

Anesthesia, epidural, general; Heart, hemodynamics; Position, supine, Trendelenburg

MeSH Terms

Anesthesia, Epidural*
Anesthesia, General
Enflurane
Epidural Space
Epinephrine
Head-Down Tilt
Hemodynamics*
Humans
Hysterectomy*
Injections, Epidural
Intubation
Lidocaine
Mortuary Practice*
Sodium
Succinylcholine
Supine Position
Vecuronium Bromide
Enflurane
Epinephrine
Lidocaine
Sodium
Succinylcholine
Vecuronium Bromide