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BMC Anesthesiol. 2017 Nov 16;17(1):153. doi: 10.1186/s12871-017-0444-x.

Observations on significant hemodynamic changes caused by a high concentration of epidurally administered ropivacaine: correlation and prediction study of stroke volume variation and central venous pressure in thoracic epidural anesthesia.

Author information

1
Department of Anesthesia and Pain Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602739, South Korea.
2
Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
3
Department of Anesthesia and Pain Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602739, South Korea. lhjksk@pusan.ac.kr.
4
Medical Research Institute, Pusan National University Hospital, Busan, South Korea. lhjksk@pusan.ac.kr.

Abstract

BACKGROUND:

Thoracic epidural anesthesia (TEA) exacerbates hypotension due to peripheral vasodilator effects following the use of general anesthetics. This study aimed to compare the hemodynamic changes caused by three different concentrations of epidural ropivacaine and to evaluate the performance of the stroke-volume variation (SVV) and central venous pressure (CVP) during TEA with general anesthesia.

METHODS:

A total of 120 patients were administered 8 mL of ropivacaine solution via epidural injection, following randomization into one of three groups based on the concentration of ropivacaine in the study solution: 0.75%, 0.375%, or 0.2%. Hemodynamics were monitored for 30 min after loading. We analyzed the hemodynamic changes in the subgroups according to an age cutoff of 60 years. Receiver operating characteristic (ROC) analysis was performed to characterize the relationship of the SVV, CVP, and a 20% decrease in the mean arterial pressure (MAP) following TEA.

RESULTS:

Data from 109 patients were analyzed. MAP and systemic vascular resistance index were significantly decreased, and SVV was significantly increased after epidural loading only in the 0.75% ropivacaine group. There was a significant difference in hemodynamics between young and elderly subgroups in the 0.75% ropivacaine group. SVV showed a negative correlation with MAP, whereas CVP showed no correlation. The ROC analysis of SVV demonstrated a weak predictive ability of a 20% decrease in MAP at 10 min after the loading dose, with an area-under-the-curve of 0.687 and a 9.5% optimal cutoff value (sensitivity, 60.6%; specificity, 68.9%).

CONCLUSIONS:

A high concentration of ropivacaine through TEA caused a significant decrease in the systemic vascular resistance and blood pressure. More significant decreases were shown in the elderly patients. Though the change of SVV showed a negative correlation with hypotension and indicated functional hypovolemia after TEA, the predictability was limited.

CLINICAL TRIALS REGISTRATION:

Number: NCT01559285 , date: January 24, 2013.

KEYWORDS:

Epidural administration; Epidural, local, ropivacaine; Stroke volume variability

PMID:
29145824
PMCID:
PMC5689170
DOI:
10.1186/s12871-017-0444-x
[Indexed for MEDLINE]
Free PMC Article

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