Modified Epidural Analgesia in Patients with Ischemic Heart Disease

Y. Al-Huraibi, V. Marinchev, B. Bartashevich, N.Bos

Department of Anaesthesiology, Al-Thawra General Modern Teaching Hospital, Sana’a, Republic of Yemen

Introduction:

The use of epidural blockade technique is becoming a more popular means of anesthesia for patients with heart disease1,2. It is generally agreed and widely taught that well perfor¬med EA offers major advantages to such patients 3,4. EA has exerted minimal influence on acid-base balance and metabolism, it has provided long-term postoperative analgesia and has diminished the use of narcotic analgesics 5,6. But EA may cause arterial hypotension due to interruption of sympathetic regulation especially in old patients and in patients with cardiovascular disorders7. The blockade of upper thoracic segments is accompanied by pharmacological denervation of heart sym¬pathetic fibers6. It is characterized by negative inotropic and chronotropic effects8,9. EA entailed peripheral re¬sistance reduction, venous tone lowering, venous stagnation and changes in blood distribution to relaxed muscles and to skin10,11.Different attempts

were undertaken to decrease negative influence of epidu¬ral blockade on haemodynamic state such as preliminary volume replacement,va¬sopressor addition to the solution of LA, vasoactive therapy, using infusion pump7,12. All these measures have usually pre¬vented extensive haemodynamic changes during anesthesia, but hypo¬tension is still and remains to be a troublesome problem of EA.
We advise administration of LA solution into epidural space with gradual increase of volume and concentration to obtain sufficient quality of analgesia with minimal haemodynamic changes.
Materials and Methods:
This study was undertaken according to guidelines laid down by the Local Ethical Committee.
The patients were fully informed and agreed to the investigation procedures. The investigated group consisted of 84 patients (54 men, 30 women), they all underwent elective surgery due to hip-fractures and

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