Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .
Thoracolumbar epidural anaesthesia and isoflurane to prevent hypertension and tachycardia in patients undergoing abdominal aortic surgery.
Cardiovascular and hormonal responses to reconstructive abdominal aortic surgery were studied in 20 patients anaesthetized either with moderate-dose fentanyl ( 20 micrograms kg-1 ) combined with isoflurane , nitrous oxide and oxygen ( n = 10 ) , or with thoracolumbar epidural bupivacaine combined with isoflurane , nitrous oxide and oxygen ( n = 10 ) . After the start of operation , hypotension occurred in four patients in the epidural group . In both groups , the aortic cross-clamping caused slight increases both in mean arterial pressure and in calculated systemic vascular resistance , and a significant decrease in cardiac index . At the same time , a marked increase in plasma vasopressin was seen in the fentanyl group . Plasma catecholamines were low in both groups . After aortic declamping , the cardiac index improved in both groups , although two patients in the fentanyl group and four patients in the epidural group were hypotensive . Post-operatively , eight patients in the fentanyl group were hypertensive , versus none in the epidural group , in which bupivacaine-fentanyl was administered epidurally . At the same time , plasma vasopressin and adrenaline increased significantly in both groups , whereas plasma noradrenaline did so only in the fentanyl group . The results suggest that thoracolumbar epidural bupivacaine combined with low-dose isoflurane in nitrous-oxide-oxygen prevents intra-operative hypertension and tachycardia , but it may cause hypotension . Post-operative hypertension and tachycardia as well as the increase in plasma noradrenaline are prevented by epidural administration of bupivacaine-fentanyl
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .