Favorable Effects of Epidural Analgesia on Hemodynamic and Oxygenation Changes Before and After Awake Period of General Anesthesia

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 7; no. 6; pp. 516 - 524
• Main Authors: HOSODA, Renko, MIZUNO, Sachiko, SHIMOMURA, Hiraku, NATSUME, Nagato, MATUURA, Masaji, ARAI, Toyohisa
• Format: Journal Article
• Language: English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 1987
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.7.516

We previously observed the variation of oxygen consumption (VO2) and hemodynamics during the awake period of general anesthesia, and found that oxygen delivery (DO2) increased in response to the marked increase in VO2, whereas mixed venous oxygen saturation decreased and the oxygen extraction ratio increased. From this, it might be suggested that the tissue oxygenation and metabolism did not operate smoothly. We speculated that the pain induced by surgical stress and the subsequent increase in plasma catecholamine levels might play an important role. In the present study, we wish to evaluate the new halogenated inhalational anesthetic sevoflurane on the changes described above. <Method and Materials> Twelve adult patients undergoing elective major surgery were separated into a sevoflurane group (n=6) and an enflurane group (n=6). Swan-Ganz and raidal artery catheters were connected, and hemodynamic, oxygenation and plasma catechoramine data were compared before and after awakeing from general anesthesia. In both groups, the changes above mentioned were remarkable. VO2 increased from 117.9±39.5ml/min to 200.4±86.5ml/min (mean±SD, p<0.05) and from 120.9±24.9ml/min to 183.2±77.0ml/min (mean±SD, p<0.1) in the sevoflurane and enflurane groups respectively. DO2 also increased in response to the VO2. However, the decline of mixed venous oxygen tension and saturation, and increase of the oxygen extraction ratio were all observed in both groups. Also, plasma catecholamine levels in both groups increased higher than normal. We found that neither sevoflurane nor enflurane had a sufficient analgesic eff et and that subsequently neither had a favorable effect on the tissue metabolim during the recovery phase of general anesthesia.