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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1998 July-August;64(7-8):313-9

language: English

Inci­dence of hypo­ten­sion and brad­y­cardia ­during inte­grated epi­dural/gen­eral ­anaesthesia. An epi­dem­i­ologic obser­va­tional ­study on 1200 con­sec­u­tive ­patients

Fanelli G. 1, Casati A. 1, Berti M. 1, Rossignoli L. 2

1 From the University ­of Milan, IRCCS H San Raf­faele - ­Milano, Department of Anaesthesiology and Intensive Care;
2 Orthopedic Traumatologic Centre, Division of Anaesthesiology and Intensive Care - Rome


Back­ground. Com­bined epi­dural/gen­eral ­anaes-thesia ­might theo­ret­i­cally empha­sise the car­di­o­vas­cular ­effects of epi­dural ­block ­alone. The ­goal of the ­present inves­ti­ga­tion was to eval­uate the inci­dence of ­both hypo­ten­sion and brad­y­cardia ­during inte­grated epi­dural/gen­eral ­anaesthesia in a mul­ti­cen­tric, obser­va­tional ­study.
­Methods. The inci­dence of clin­ical hypo­ten­sion (sys­tolic arte­rial ­blood pres­sure ­decrease by 30% or ­more ­from base­line), and brad­y­cardia (­heart ­rate <50 ­beats/min) and ­other ­side ­effects ­have ­been eval­u­ated in 1200 con­sec­u­tive ­patients ­receiving inte­grated epi­dural/gen­eral ­anaesthesia. The ­time ­from induc­tion of epi­dural ­anaesthesia to induc­tion of gen­eral ­anaesthesia was con­sid­ered as pre­op­er­a­tive; ­while the ­time ­after gen­eral ­anaesthesia induc­tion was con­sid­ered as intra­op­er­a­tive.
­Results. Pre­op­er­a­tively hypo­ten­sion devel­oped in 85 ­patients (2.8%), and brad­y­cardia in 54 ­patients (4.5%). Intra­op­er­a­tively, hypo­ten­sion was ­observed in 380 ­patients (31.6%), and brad­y­cardia in 153 ­patients (12.7%). Hypo­ten­sion and brad­y­cardia ­were not influ­enced by the ­type of sur­gical pro­ce­dure, the ­type of main­te­nance of gen­eral ­anaesthesia (inha­la­tional ­versus ­total intra­ve­nous gen­eral ­anaesthesia) and the ­level of epi­dural ­block (­lumbar ­versus tho­racic); but ­they ­were ­more fre­quent in ­patients ­with ASA phys­ical ­status II and III-IV com­pared to ­patients ­with ASA phys­ical ­status I (p<0.05). Pro­phy­lactic ­volume pre­load ­decreased the inci­dence of hypo­ten­sion ­from 41.5% to 22.4% (p<0.0001), ­while pro­phy­lactic atro­pine ­before epi­dural ­block did not ­affect the inci­dence of brad­y­cardia. ­Patients ­receiving epi­dural clon­i­dine ­showed an ­increased inci­dence of intra­op­er­a­tive brad­y­cardia com­pared to ­those who did not ­receive it (p<0.0001).
Dis­cus­sion. Ran­dom­ized, con­trolled ­studies ­should be advo­cated in ­order to com­pare the inci­dence of hypo­ten­sion and brad­y­cardia ­during inte­grated ­anaesthesia and ­during epi­dural ­block ­alone. Our ­results dem­on­strated ­that the use of inte­grated epi­dural/gen­eral ­anaesthesia pro­duces an inci­dence of per­i­op­er­a­tive hypo­ten­sion and brad­y­cardia sim­ilar to ­that ­reported ­when cen­tral ­blocks are ­used ­alone.

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