Biventricular function in exercise during autonomic (thoracic epidural) block
Why the study?
To further investigate the effect of cardiac sympathicolysis via thoracic epidural anesthesia on biventricular function during physical stress and increased oxygen demand.
Does thoracic epidural anesthesia alter biventricular function and hemodynamics during dynamic exercise in patients scheduled for thoracic surgery?
Population
12 patients scheduled to undergo thoracic surgery
Comparison
Dynamic ergometric exercise with vs without thoracic epidural anesthesia
Design
Cross-over study
Authors
Discussion
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Member takes
Implication
TEA reduces resting biventricular systolic function yet preserves exercise-induced augmentation; leaves open whether sympathetic blockade limits cardiovascular reserve in higher-risk patients.
Key Points
- To investigate the effects of cardiac sympathetic blockade induced by thoracic epidural anesthesia on left and right ventricular function during dynamic physical exercise.
- Conducted a cross-over interventional trial in 12 patients scheduled for thoracic surgery (Nederlands Trial Register, NTR 4880).
- Patients underwent dynamic ergometric exercise tests both with and without thoracic epidural anesthesia (TEA).
- Evaluated hemodynamics and biventricular function using transthoracic two-dimensional and M-mode echocardiography, pulsed wave Doppler, and tissue Doppler imaging.
- Thoracic epidural anesthesia attenuated resting right ventricular systolic function (TV S': -21%, P < 0.001), left ventricular systolic function (MV S': -14%, P = 0.025), heart rate (-11%, P < 0.001), stroke volume index (-15%, P = 0.006), cardiac index (-21%, P < 0.001), and mean arterial pressure (-12%, P < 0.001).
- Dynamic exercise significantly augmented hemodynamics across conditions, increasing heart rate (+86%, P < 0.001), stroke volume index (+19%, P < 0.001), cardiac index (+124%, P < 0.001), and mean arterial pressure (+17%, P < 0.001), while reducing systemic vascular resistance (-49%, P < 0.001).
- No significant interaction occurred between exercise and thoracic epidural anesthesia for biventricular functional parameters, with interactions detected only for rate-pressure product (P = 0.024) and mitral valve E deceleration time (P = 0.035).
Structured PICO
Does thoracic epidural anesthesia alter biventricular function and hemodynamics during dynamic exercise in patients scheduled for thoracic surgery?
P
Population
12 patients scheduled to undergo thoracic surgery
I
Intervention
Thoracic epidural anesthesia (TEA) during dynamic ergometric exercise tests
C
Comparator
Dynamic ergometric exercise tests without thoracic epidural anesthesia (cross-over design)
O
Outcome
Biventricular function measured by transthoracic two-dimensional and M-mode echocardiography, pulsed wave Doppler and tissue Doppler imaging, and hemodynamicssurrogate
Cardiac sympathetic blockade by thoracic epidural anesthesia reduces resting biventricular systolic function but does not blunt exercise-induced functional augmentation, suggesting alternative regulatory mechanisms during exercise.
Cite This Study
Wink et al. (2021) studied this question.