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CARDIOVASCULAR ANESTHESIA

Thoracic Epidural Anesthesia Combined with General Anesthesia: The Preferred Anesthetic Technique for Thoracic Surgery

Vera Von Dossow, MD^*, Martin Welte, MD, Ulrich Zaune, MD^§, Eike Martin, MD^||, Michael Walter, MD, Jens Rückert, MD, Wolfgang J. Kox, MD, PhD^*, and Claudia D. Spies, MD^*

*Department of Anesthesiology and Operative Intensive Care Medicine, Department of Surgery, University Hospital Charité, Campus Charité Mitte, Humboldt-University, Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Universitätsklinikum Benjamin Franklin, Free University, Berlin, §Department of Anesthesiology, Evangelisches Krankenhaus, Düsseldorf, and ||Department of Anesthesiology and Operative Intensive Care Medicine, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany

Address correspondence and reprint requests to Claudia D. Spies, MD, Klinik für Anaesthesiologie und operative Intensivmedizin, Universitätsklinik Charité, Campus Charité Mitte, Humboldt-Universität zu Berlin, Schumannstr. 20/21, 10117 Berlin, Germany. Address e-mail to claudia.spies{at}charite.de

Thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) as well as total-IV anesthesia (TIVA) are both established anesthetic managements for thoracic surgery. We compared them with respect to hypoxic pulmonary vasoconstriction, shunt fraction and oxygenation during one-lung ventilation. Fifty patients, ASA physical status II-III undergoing pulmonary resection were randomly allocated to two groups. In the TIVA group, anesthesia was maintained with propofol and fentanyl. In the TEA group, anesthesia was maintained with TEA (bupivacaine 0.5%) combined with low-dose concentration 0.3–0.5 vol% of isoflurane (end-tidal). Changing from two-lung ventilation to one-lung ventilation caused a significant increase in cardiac output (CO) in the TIVA group, whereas no change was observed in the TEA group. One-lung ventilation caused significant increases in shunt fraction in both groups which was associated per definition with a significant decrease in PaO₂ in both groups but PaO₂ remained significantly increased in the TEA group (P < 0.05). We conclude that both anesthetic regimens are safe intraoperatively. However, TEA in combination with GA did not impair arterial oxygenation to the same extent as TIVA, which might be a result of the changes in CO. Therefore, patients with preexisting cardiopulmonary disease and impaired oxygenation before one-lung ventilation might benefit from TEA combined with GA.

Implications: Fifty patients underwent lung surgery through the opened chest wall requiring ventilation of only one lung. Patients were randomly assigned to receive either general anesthesia alone or in combination with regional anesthesia via a catheter in the back. Oxygen content in the blood and blood pressure was better maintained in the group receiving the combination of general with regional anesthesia.

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