JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Schmidt, C. Articles by Berendes, E. Search for Related Content PubMed PubMed Citation Articles by Schmidt, C. Articles by Berendes, E. Related Collections Surgery Cardiovascular Regional Anesthesia

---

CARDIOVASCULAR ANESTHESIA

The Effect of High Thoracic Epidural Anesthesia on Systolic and Diastolic Left Ventricular Function in Patients with Coronary Artery Disease

Christoph Schmidt, MD^*, Frank Hinder, MD, PhD^*, Hugo Van Aken, MD, PhD, FRCA, FANZCA^*, Gregor Theilmeier, MD^*, Christian Bruch, MD, PhD, Stefan P. Wirtz, MD^*, Hartmut Bürkle, MD, PhD^*, Tim Gühs, MD^*, Markus Rothenburger, MD, PhD, and Elmar Berendes, MD, PhD^*

Departments of *Anesthesiology and Surgical Intensive-Care Medicine, Cardiology, and Chest, Heart, and Vascular Surgery, University of Münster Hospital, Germany

Address correspondence and reprint requests to Christoph Schmidt, MD, Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany. Address e-mail to schmch{at}uni-muenster.de.

In patients with coronary artery disease, vasoconstriction is induced through activation of the sympathetic nervous system. Both ₁- and ₂-adrenergic epicardial and microvascular constriction are potent initiators of myocardial ischemia. Attenuation of ischemia has been observed when sympathetic nervous system activity is inhibited by high thoracic epidural anesthesia (HTEA). However, it is still a matter of controversy whether establishing HTEA may correspondingly translate into an improvement of left ventricular (LV) function. To clarify this issue, LV function was quantified serially before and after HTEA using a new combined systolic/diastolic variable of global LV function (myocardial performance index [MPI]) and additional variables that more specifically address systolic (e.g., fractional area change) or diastolic function (e.g., intraventricular flow propagation velocity [V_p]). High thoracic epidural catheters were inserted in 37 patients scheduled for coronary artery surgery, and HTEA was administered in the awake patients. Echocardiographic and hemodynamic measures were recorded before and after institution of HTEA. HTEA induced a significant improvement in diastolic LV function (e.g., V_p changed from 45.1 ± 16.1 to 53.8 ± 18.8 cm/s; P < 0.001), whereas indices of systolic function did not change. The change in the diastolic characteristics caused the MPI to improve from 0.51 ± 0.13 to 0.35 ± 0.13 (P < 0.001). We conclude that an improvement in cardiac function was due to improved diastolic characteristics.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999