Korean J Anesthesiol.  2005 Sep;49(3):314-320. 10.4097/kjae.2005.49.3.314.

The Cardiovascular Effects of Thoracic Bolus Epidural Injection of Lidocaine, Morphine and Fentanyl during Sevoflurane General Anesthesia

• Shin H
• Oh S
• Jang M
• Lee I
• Lee M
• Lim S
• Kim N
• Kong M

• KMID: 2299128
• DOI: http://doi.org/10.4097/kjae.2005.49.3.314

Abstract

BACKGROUND: Sevoflurane is an inhalational anesthetic that produces rapid induction, emergence and little cardiovascular depression. Elevated sympathetic activity during surgery produces undesirable effects on the cardiovascular system, such as hypertension, tachycardia or arrhythmias. So combined general and epidural anesthesia have been used recently for the operation, especially the abdominal surgery. This study was performed to evaluate the cardiovascular effects of thoracic epidural anesthesia during sevoflurane general anesthesia.
METHODS
Forty patients of ASA class 1-2 undergoing elective subtotal gastrectomy were divided into 5 groups. Thoracic epidural bolus injection was administered via an epidural catheter during sevoflurane general anesthesia in a double-blind random manner: Group 1; normal saline (N/S) 10 ml (placebo), Group 2; morphine 0.1 mg/kg mixed with N/S in 10 ml, Group 3; fentanyl 1 mcg/kg mixed with N/S in 10 ml, Group 4; 1% lidocaine 10 ml, and Group 5; 1% lidocaine 10 ml mixed with morphine 0.1 mg/kg and fentanyl 1 mcg/kg. Systolic and diastolic blood pressures, pulse rates, peripheral oxygen saturation levels (SpO2) and end-tidal carbon dioxide partial pressures (ETCO2) were measured every 5 minutes.
RESULTS
Systolic and diastolic blood pressures were significantly reduced from 10 minutes after epidural bolus injection in groups 4 and 5, but these decreases in blood pressure were not severe enough to require treatment in either group. Pulse rates were significantly decreased from 10 minutes after injection in groups 3, 4, and 5, but these decreases in pulse rate were not so severe enough to require treatment in 3 groups. SpO2 and ETCO2 were stable, and arrhythmia was not observed.
CONCLUSIONS
The thoracic epidural injection of 1% lidocaine mixed with morphine 0.1 mg/kg and fentanyl 1 mcg/kg can be safely used during sevoflurane anesthesia without severe cardiovascular complications during upper abdominal surgery in ASA 1-2 patients.

Keyword

sevoflurane; thoracic epidural anesthesia; lidocaine; morphine; fentanyl

MeSH Terms

Anesthesia
Anesthesia, Epidural
Anesthesia, General*
Arrhythmias, Cardiac
Blood Pressure
Carbon Dioxide
Cardiovascular System
Catheters
Depression
Fentanyl*
Gastrectomy
Heart Rate
Humans
Hypertension
Injections, Epidural*
Lidocaine*
Morphine*
Oxygen
Partial Pressure
Tachycardia
Carbon Dioxide
Fentanyl
Lidocaine
Morphine
Oxygen