Education  |   March 2019
Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function
Author Notes
  • From the Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands (J.W., B.T.V., L.P.H.J.A.); and Department of Anesthesia and Perioperative Medicine, Ghent University, Ghent, Belgium (P.F.W.).
  • Submitted for publication October 19, 2017. Accepted for publication October 31, 2018.
    Submitted for publication October 19, 2017. Accepted for publication October 31, 2018.×
  • This article is featured in “This Month in Anesthesiology,” page 5A.
    This article is featured in “This Month in Anesthesiology,” page 5A.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Wink: Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. j.wink@lumc.nl. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Cardiovascular Anesthesia / Regional Anesthesia
Education   |   March 2019
Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function
Anesthesiology 3 2019, Vol.130, 472-491. doi:10.1097/ALN.0000000000002558
Anesthesiology 3 2019, Vol.130, 472-491. doi:10.1097/ALN.0000000000002558
Abstract

Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia–induced sympatholysis and cardiovascular control mechanisms. Perhaps these new insights may help identify conditions in which benefits of thoracic epidural anesthesia may not outweigh potential risks. For example, cardiac sympathectomy with high-thoracic epidural anesthesia decreases right ventricular function and attenuates its capacity to cope with increased right ventricular afterload. Although the clinical significance of this pathophysiologic interaction is unknown at present, it identifies a subgroup of patients with established or pending pulmonary hypertension for whom outcome studies are needed. Other new areas of interest include the impact of thoracic epidural anesthesia–induced sympatholysis on cardiovascular control in conditions associated with increased sympathetic tone, surgical stress, and hemodynamic disruption. It was considered appropriate to collect and analyze all recent scientific information on this subject to provide a comprehensive update on the cardiovascular effects of high-thoracic epidural anesthesia and cardiac sympathectomy in healthy and diseased patients.