What is the clinical evidence from this study?

Study design: RCT. Population: Acute pulmonary hypertension and right ventricular pressure overload (n=18). Intervention: Thoracic epidural anaesthesia (TEA) vs. Lumbar epidural anaesthesia (LEA) or isotonic saline control. Primary outcome: Right ventricular contractility (mW s ml-1).

What does this research mean for the field?

Thoracic epidural anaesthesia decreases right ventricular contractility and cardiac output during acute pulmonary hypertension by blocking cardiac sympathetic nerves, independent of changes in systemic vasodilation or coronary flow. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether selective thoracic epidural anaesthesia exerts negative inotropic effects on the right ventricle during established acute pulmonary hypertension, independent of vascular tone, coronary flow, or oxygen balance.

April 19, 2011European Journal of Anaesthesiology

Thoracic epidural anaesthesia disrupts the protective mechanism of homeometric autoregulation during right ventricular pressure overload by cardiac sympathetic blockade: a randomised controlled animal study

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Key result

Thoracic epidural anaesthesia decreased right ventricular contractility (1.5 vs 3.2 mW s ml-1) and cardiac output (1.8 vs 2.4 l min-1) during acute pulmonary hypertension in pigs.

Why the study?

Does thoracic epidural anaesthesia reduce right ventricular contractility in a pig model of acute pulmonary hypertension?

Population

18 pigs with induced acute pulmonary hypertension

Comparison

Thoracic epidural anaesthesia with 1 ml… vs Lumbar epidural anaesthesia with 4 ml…

Design

Preclinical, Randomised

Follow-up

30 min

Authors

CMCarlo MissantApple (Israel)SRSteffen RexKU Leuven PCPiet ClausCardiac Imaging

Discussion

Member takes

Implication

May caution against thoracic epidural anaesthesia in acute pulmonary hypertension; leaves open translation to humans.

Key Points

To evaluate whether selective thoracic epidural anaesthesia exerts negative inotropic effects on the right ventricle during established acute pulmonary hypertension, independent of vascular tone, coronary flow, or oxygen balance.
Eighteen pigs underwent pulmonary artery constriction to induce acute right ventricular pressure overload in a randomized, placebo-controlled laboratory protocol.
Stabilized animals were allocated to receive thoracic epidural anaesthesia (n = 6, 1 ml bupivacaine 0.5%), lumbar epidural anaesthesia (n = 6, 4 ml bupivacaine 0.5%), or control saline (n = 6).
Sympathetic blockade extent was verified via thermography, and right ventricular contractility, cardiac output, coronary flow, and oxygen dynamics were assessed 30 minutes post-block.
Thoracic epidural anaesthesia caused sympathetic blockade from C6 to T6 and reduced right ventricular contractility (1.5 ± 0.6 vs. 3.2 ± 0.9 mW s ml⁻¹) and cardiac output (1.8 ± 0.3 vs. 2.4 ± 0.3 l min⁻¹) without changing systemic vascular resistance.
Lumbar epidural anaesthesia decreased systemic vascular resistance without altering right ventricular contractility, and right ventricular coronary flow, oxygen delivery, and oxygen consumption remained comparable across all groups.

Study Design

Type

RCT (n=18)

Randomization

Randomized

Multicenter

Structured PICO

Does thoracic epidural anaesthesia reduce right ventricular contractility in a pig model of acute pulmonary hypertension?

Population

18 pigs with induced acute pulmonary hypertension (right ventricular pressure overload by constricting the pulmonary artery)

Intervention

Thoracic epidural anaesthesia (TEA) with 1 ml bupivacaine 0.5%

Comparator

Lumbar epidural anaesthesia (LEA) with 4 ml bupivacaine 0.5% or control (isotonic saline)

Outcome

Right ventricular contractility and cardiac output at 30 min after induction of epidural anaesthesiasurrogate

Main Result

Absolute Event Rate: 1.5% vs 3.2%

In a pig model of acute pulmonary hypertension, thoracic epidural anaesthesia abolished the protective adaptation of right ventricular contractility, leading to deteriorated systemic hemodynamics.

Cite This Study

Missant et al. (2011) conducted an RCT in Acute pulmonary hypertension and right ventricular pressure overload (n=18). Thoracic epidural anaesthesia (TEA) vs. Lumbar epidural anaesthesia (LEA) or isotonic saline control was evaluated on Right ventricular contractility (mW s ml-1). Thoracic epidural anaesthesia decreased right ventricular contractility (1.5 vs 3.2 mW s ml-1) and cardiac output (1.8 vs 2.4 l min-1) during acute pulmonary hypertension in pigs.

synapsesocial.com/papers/6a18f84ea6ebdba58ad307a2 https://doi.org/10.1097/eja.0b013e328346adf3

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Thoracic epidural anaesthesia disrupts the protective mechanism of homeometric autoregulation during right ventricular pressure overload by cardiac sympathetic blockade: a randomised controlled animal study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Thoracic epidural anaesthesia disrupts the protective mechanism of homeometric autoregulation during right ventricular pressure overload by cardiac sympathetic blockade: a randomised controlled animal study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider