Anestesia Epidural Torácica
DOI:
https://doi.org/10.30445/rear.v3i6.448Palabras clave:
analgesia epidural, dolor, formación, torácicaResumen
La anestesia epidural es una técnica ampliamente usada en Anestesiología. El primero de los abordajes que se aprende de esta técnica es a nivel lumbar. La colocación de un catéter epidural a nivel torácico alto, ha sido descrita hace tiempo para su uso en cirugía torácica.
Dos razones importantes hacen que el anestesiólogo sea reacio al uso del abordaje torácico de la anestesia epidural: Una, las dificultades técnicas de la inserción y colocación de un catéter epidural y, en segundo lugar, el miedo a lesionar la medula espinal. El motivo de esta revisión acerca de la anestesia epidural torácica es aumentar el conocimiento y las ventajas de su uso.
Vascocellos describió el uso de la anestesia epidural (presumiblemente torácica) para la cirugía torácica, y posteriormente en 1948, Fujikawa et al publicaron los resultados de las 100 primeras anestesias epidurales torácicas (AET) realizadas para cirugía torácica en el Missouri State Tuberculosis Sanatorium. En 1951 el equipo de Crawford, ya mencionado, amplió el trabajo de Fujikawa con más de 677 epidurales torácicas, realizadas en cirugía torácica con pacientes despiertos y en ventilación espontánea. Describieron excelentes condiciones quirúrgicas sin los problemas propios de respiración paradójica ni bamboleo mediastínico propio en un tórax abierto en ventilación espontánea. Se añadió anestesia con óxido nitroso a tan solo el 5% de los pacientes estudiados y la única complicación intraoperatoria que se observó fue tos paroxística ocasional en algunos pacientes al ligar los segmentos bronquiales. El éxito de este abordaje anestésico en este tipo de cirugía se consigue con una muy buena comunicación con el paciente, buena colaboración por parte del mismo, así como un gran conocimiento de la técnica quirúrgica por parte del cirujano.
John bonica describe su experiencia con más de 1000 pacientes usando un abordaje paramedial, de mayor utilidad en la anestesia epidural torácica donde la angulación de las apófisis espinosas es más pronunciada y por tanto dificulta la técnica medial.
Citas
1.- Crawford OB, Ottesen P, Buckingham WW, Brasher CA. Peridural anesthesia in thoracic surgery. A review of 677 cases. Anesthesiology 1951; 12: 73-95.
2.- Vasconcelos E. Cancer of the esophagus: original technique for total esophagectomy. Diseases of the Chest 1944; 10: 471-480.
3.- Fujikawa YF, Neves A, Brasher CA et al. Epidural anesthesia in thoracic surgery. J Thorac Surg. 1948 Feb;17(1):123-34.
4.- Bonica J. Continuous peridural block. Anesthesiology 1956; 17: 626-630.
5.- O'Connor CJ. Thoracic epidural analgesia: Physiologic effects and clinical applications. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):595-609.
6.- Dawkins & Steel. Thoracic extradural block for upper abdominal surgery. Anaesthesia. 1971 Jan;26(1):41-8.
7.- Simpson BR, Parkhouse J, Marshall R, Lambrechts W. Extradural analgesia and the prevention of postoperative respiratory complications. Br J Anaesth. 1961 Dec;33:628-41.
8.- Reinhart K, Foehring U, Kersting T, Schaefer M, Bredle D, Hirner A, Eyrich K. Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship. Anesth Analg. 1989 Sep;69(3):360-9.
9.- O'Connor CJ. Thoracic epidural analgesia: Physiologic effects and clinical applications. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):595-609.
10.- Saada M, Catoire P, Bonnet F, Delaunay L, Gormezano G, Macquin-Mavier I, Brun P. Effecte of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. Anesth Analg. 1992 Sep;75(3):329-35.
11.- Blomberg S, Ricksten S. Effects of thoracic epidural anaesthesia on central haemodynamics compared to cardiac beta adrenoreceptor blockage in conscious rats with acute myocardial infarction. Acta Anaesthesiol Scand. 1990 Jan;34(1):1-7.
12.- Blomberg S, Curelaru I, Emanuelsson H, Herlitz J, Pontén J, Ricksten SE. Thoracic epidural anaesthesia in patients with unstable angina pectoris. Eur Heart J. 1989 May;10(5):437-44.
13.- Blomberg SG. Long term home self treatment with high thoracic epidural anesthesia in patients with severe coronary artery disease. Anesth Analg. 1994 Sep;79(3):413-21.
14.- Kock M, Blomberg S, Emanuelsson H, Lomsky M, Strömblad SO, Ricksten SE. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Anesth Analg. 1990 Dec;71(6):625-30.
15.- Blomberg S, Ernanuelsson H, Krist H et al. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 1990; 73: 840-847.
16.- Speight KL, Rauck RL, Mann JF. The effect of thoracic epidural anesthesia on pulmonary function in normals. Anesthesiology 1991; 75: A729.
17.- Pansard JL, Mankikian B, Bertrand M et al. Effects of thoracic extradural block on diaphragmatic electrical activity and contractility after upper abdominal surgery. Anesthesiology. 1993 Jan;78(1):63-71.
18.- Tanaka K, Shono S, Watanabe R et al. Incidence of asthmatic shock is not increased during high epidural anesthesia: an analysis of 1,063 asthmatics. Anesthesiology 1992; 77: A1090.
19.- Scheinin B, Asantila B, Orko R The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiologica Scandinavica 1987; 31: 161-170.
20.- Katz Journal of, Kavanagh B, Sandler A. Pre-emptive analgesia: clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology 1991; 77: 439-446.
21.- Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. British Journal of Anaesthesia 1993; 70: 434-439.
22.- Nesmith RL, Herring SR, Marks M et al. Early experience with high thoracic epidural anesthesia in outpatient submuscular breast augmentation. Annals of Plastic Surgery 1990; 24: 299-303.
23.- Burgess FW, Colonna T, Anderson DM et al. Postoperative referred pain following thoracotomy. Anesthesiology 1992; 77: A867.
24.- Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology 1994; 81: 737-759.
25.- Brodsky JB, Chaplan SR, Brose WG et al. Continuous epidural hydromorphone for post-thoracotomy pain relief. Annals of Thoracic Surgery 1990; 50: 888-893.
26.- Benzon HT, Wong HY, Belavic A et al. A randomised double-blind comparison of epidural fentanyl infusion vs. patient controlled analgesia with morphine for post-thoracotomy pain. Anesthesia and Analgesia 1993; 76: 316-322.
27.- Salomaki TE, Laitinen 10, Nuutinen LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology 1991; 75: 790-795.
28.- Guinard JP, Mavrocordatos P, Chiolero R, Carpenter RL. A randomised comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology 1992; 77: 1108-1115.
29.- Sawchuk CW, Ong B, Unruh HW, Horan TA, Greengrass R. Thoracic versus lumbar epidural fentanyl for postthoracotomy pain. Ann Thorac Surg. 1993 Jun;55(6):1472-6.
30.- Swenson J, Bready R, Hollander M. A comparison of thoracic vs. lumbar epidural sufentanil for postthoracotomy pain using PCA. Anesthesiology 1992; 77: A828.
31.- Etches RC, Sandler AN, Daley MD. Respiratory depression and spinal opioids. Canadian Journal of Anaesthesia 1989; 36: 165-185.
32.- Conacher ID. Pain relief after thoracotomy. British Journal of Anaesthesia 1990; 65: 806-812.
33.- Mourisse J, Hasenbos MA, Gielen MJ et al. Epidural bupivacaine, sufentanil, or the combination for post-thoracotomy pain. Acta Anaesthesiologica Scandinavica 1992; 36: 70-74.
34.- Liem TH, Booij LH, Hasenbos MA et al. Coronary artery bypass grafting using two different anesthetic techniques. Haemodynamic results: Part I. Journal of Cardiothoracic and Vascular Anesthesia 1992; 6: 148-155.
35.- Liem TH, Hasenbos MA, Booij LH et al. Coronary artery bypass grafting using two different anesthetic techniques: Part II. Postoperative outcome. Journal of Cardiothoracic and Vascular Anesthesia 1992; 6: 156-161.
36.- Liem TH, Hasenbos MA, Booij LH et al. Coronary artery bypass grafting using two different anesthetic techniques: Part III. Postoperative outcome. Journal of Cardiothoracic and Vascular Anesthesia 1992; 6: 162-167.
37.- Stevens DS. Epidural hematoma. Was catheter removed during complete anticoagulation? Anesthesia and Analgesia 1992; 75: S63.
38.- Mackersie RC, Shackford SR, Hoyt DB et al. Continuous epidural fentanyl analgesia: ventilatory function improvement with routine use in treatment of blunt chest injury. Joumal of Trauma 1987; 27: 1207-1212.
39. Bigler D, Moller J, Kamp-Jensen M, Berthelsen 0, Hjortso Ne, Kehlet H. Effect of piroxicam in addition to continuous thoracic epidural bupivacaine and morphine on postoperative pain and lung function after thoracotomy. Acta Anaesthesiologica Scandinavica 1992; 63: 647-650.
40.- Benzon HT. Post-thoracotomy epidural analgesia: lumbar or thoracic placement? Joumal of Cardiothoracic and Vascular Anesthesia 1993; 7: 515-516.
41.- Dawkins CJM. An analysis of the complications of extradural and caudal block. Anaesthesia 1969; 24: 554-563.
42.- Bromage PR The control of post-thoracotomy pain. Anaesthesia 1989; 44: 445-446.
43.- Aguilar JL, Samper D, Montes A, Llorente e, Faura A, Vidal F. Thoracic epidural block does not prevent post-thoracotomy pain. Regional Anesthesia 1992; 17: S148.
44.- Aguilar JL, Cubells e, RinconR, Preciado MI, Valldeperas I, Vidal F. Pre-emptive analgesia following epidural 0.5% bupivacaine in thoracotomy. Regional Anesthesia 1994; 19: sn.
45.- Moiniche S, Hjortso NC, Blemmer T, Dahl JB, Kehlet H. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine. Acta Anaesthesiologica Scandinavica 1993; 37: 65-69.
46.- Cousins MJ, Bromage PR Epidural neural blockade. In Cousins MJ, Bridenbaugh PO (eds). Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia, PA, Lippincott, 1988; 253-347.
47.- Conacher ID. Pain relief following thoracic surgery. In: Gothard JWW, ed. Thoracic Anaesthesia. London, Bailliere Tindall, 1987; 240-243.
2.- Vasconcelos E. Cancer of the esophagus: original technique for total esophagectomy. Diseases of the Chest 1944; 10: 471-480.
3.- Fujikawa YF, Neves A, Brasher CA et al. Epidural anesthesia in thoracic surgery. J Thorac Surg. 1948 Feb;17(1):123-34.
4.- Bonica J. Continuous peridural block. Anesthesiology 1956; 17: 626-630.
5.- O'Connor CJ. Thoracic epidural analgesia: Physiologic effects and clinical applications. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):595-609.
6.- Dawkins & Steel. Thoracic extradural block for upper abdominal surgery. Anaesthesia. 1971 Jan;26(1):41-8.
7.- Simpson BR, Parkhouse J, Marshall R, Lambrechts W. Extradural analgesia and the prevention of postoperative respiratory complications. Br J Anaesth. 1961 Dec;33:628-41.
8.- Reinhart K, Foehring U, Kersting T, Schaefer M, Bredle D, Hirner A, Eyrich K. Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship. Anesth Analg. 1989 Sep;69(3):360-9.
9.- O'Connor CJ. Thoracic epidural analgesia: Physiologic effects and clinical applications. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):595-609.
10.- Saada M, Catoire P, Bonnet F, Delaunay L, Gormezano G, Macquin-Mavier I, Brun P. Effecte of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. Anesth Analg. 1992 Sep;75(3):329-35.
11.- Blomberg S, Ricksten S. Effects of thoracic epidural anaesthesia on central haemodynamics compared to cardiac beta adrenoreceptor blockage in conscious rats with acute myocardial infarction. Acta Anaesthesiol Scand. 1990 Jan;34(1):1-7.
12.- Blomberg S, Curelaru I, Emanuelsson H, Herlitz J, Pontén J, Ricksten SE. Thoracic epidural anaesthesia in patients with unstable angina pectoris. Eur Heart J. 1989 May;10(5):437-44.
13.- Blomberg SG. Long term home self treatment with high thoracic epidural anesthesia in patients with severe coronary artery disease. Anesth Analg. 1994 Sep;79(3):413-21.
14.- Kock M, Blomberg S, Emanuelsson H, Lomsky M, Strömblad SO, Ricksten SE. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Anesth Analg. 1990 Dec;71(6):625-30.
15.- Blomberg S, Ernanuelsson H, Krist H et al. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 1990; 73: 840-847.
16.- Speight KL, Rauck RL, Mann JF. The effect of thoracic epidural anesthesia on pulmonary function in normals. Anesthesiology 1991; 75: A729.
17.- Pansard JL, Mankikian B, Bertrand M et al. Effects of thoracic extradural block on diaphragmatic electrical activity and contractility after upper abdominal surgery. Anesthesiology. 1993 Jan;78(1):63-71.
18.- Tanaka K, Shono S, Watanabe R et al. Incidence of asthmatic shock is not increased during high epidural anesthesia: an analysis of 1,063 asthmatics. Anesthesiology 1992; 77: A1090.
19.- Scheinin B, Asantila B, Orko R The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiologica Scandinavica 1987; 31: 161-170.
20.- Katz Journal of, Kavanagh B, Sandler A. Pre-emptive analgesia: clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology 1991; 77: 439-446.
21.- Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. British Journal of Anaesthesia 1993; 70: 434-439.
22.- Nesmith RL, Herring SR, Marks M et al. Early experience with high thoracic epidural anesthesia in outpatient submuscular breast augmentation. Annals of Plastic Surgery 1990; 24: 299-303.
23.- Burgess FW, Colonna T, Anderson DM et al. Postoperative referred pain following thoracotomy. Anesthesiology 1992; 77: A867.
24.- Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology 1994; 81: 737-759.
25.- Brodsky JB, Chaplan SR, Brose WG et al. Continuous epidural hydromorphone for post-thoracotomy pain relief. Annals of Thoracic Surgery 1990; 50: 888-893.
26.- Benzon HT, Wong HY, Belavic A et al. A randomised double-blind comparison of epidural fentanyl infusion vs. patient controlled analgesia with morphine for post-thoracotomy pain. Anesthesia and Analgesia 1993; 76: 316-322.
27.- Salomaki TE, Laitinen 10, Nuutinen LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology 1991; 75: 790-795.
28.- Guinard JP, Mavrocordatos P, Chiolero R, Carpenter RL. A randomised comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology 1992; 77: 1108-1115.
29.- Sawchuk CW, Ong B, Unruh HW, Horan TA, Greengrass R. Thoracic versus lumbar epidural fentanyl for postthoracotomy pain. Ann Thorac Surg. 1993 Jun;55(6):1472-6.
30.- Swenson J, Bready R, Hollander M. A comparison of thoracic vs. lumbar epidural sufentanil for postthoracotomy pain using PCA. Anesthesiology 1992; 77: A828.
31.- Etches RC, Sandler AN, Daley MD. Respiratory depression and spinal opioids. Canadian Journal of Anaesthesia 1989; 36: 165-185.
32.- Conacher ID. Pain relief after thoracotomy. British Journal of Anaesthesia 1990; 65: 806-812.
33.- Mourisse J, Hasenbos MA, Gielen MJ et al. Epidural bupivacaine, sufentanil, or the combination for post-thoracotomy pain. Acta Anaesthesiologica Scandinavica 1992; 36: 70-74.
34.- Liem TH, Booij LH, Hasenbos MA et al. Coronary artery bypass grafting using two different anesthetic techniques. Haemodynamic results: Part I. Journal of Cardiothoracic and Vascular Anesthesia 1992; 6: 148-155.
35.- Liem TH, Hasenbos MA, Booij LH et al. Coronary artery bypass grafting using two different anesthetic techniques: Part II. Postoperative outcome. Journal of Cardiothoracic and Vascular Anesthesia 1992; 6: 156-161.
36.- Liem TH, Hasenbos MA, Booij LH et al. Coronary artery bypass grafting using two different anesthetic techniques: Part III. Postoperative outcome. Journal of Cardiothoracic and Vascular Anesthesia 1992; 6: 162-167.
37.- Stevens DS. Epidural hematoma. Was catheter removed during complete anticoagulation? Anesthesia and Analgesia 1992; 75: S63.
38.- Mackersie RC, Shackford SR, Hoyt DB et al. Continuous epidural fentanyl analgesia: ventilatory function improvement with routine use in treatment of blunt chest injury. Joumal of Trauma 1987; 27: 1207-1212.
39. Bigler D, Moller J, Kamp-Jensen M, Berthelsen 0, Hjortso Ne, Kehlet H. Effect of piroxicam in addition to continuous thoracic epidural bupivacaine and morphine on postoperative pain and lung function after thoracotomy. Acta Anaesthesiologica Scandinavica 1992; 63: 647-650.
40.- Benzon HT. Post-thoracotomy epidural analgesia: lumbar or thoracic placement? Joumal of Cardiothoracic and Vascular Anesthesia 1993; 7: 515-516.
41.- Dawkins CJM. An analysis of the complications of extradural and caudal block. Anaesthesia 1969; 24: 554-563.
42.- Bromage PR The control of post-thoracotomy pain. Anaesthesia 1989; 44: 445-446.
43.- Aguilar JL, Samper D, Montes A, Llorente e, Faura A, Vidal F. Thoracic epidural block does not prevent post-thoracotomy pain. Regional Anesthesia 1992; 17: S148.
44.- Aguilar JL, Cubells e, RinconR, Preciado MI, Valldeperas I, Vidal F. Pre-emptive analgesia following epidural 0.5% bupivacaine in thoracotomy. Regional Anesthesia 1994; 19: sn.
45.- Moiniche S, Hjortso NC, Blemmer T, Dahl JB, Kehlet H. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine. Acta Anaesthesiologica Scandinavica 1993; 37: 65-69.
46.- Cousins MJ, Bromage PR Epidural neural blockade. In Cousins MJ, Bridenbaugh PO (eds). Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia, PA, Lippincott, 1988; 253-347.
47.- Conacher ID. Pain relief following thoracic surgery. In: Gothard JWW, ed. Thoracic Anaesthesia. London, Bailliere Tindall, 1987; 240-243.
Publicado
2011-06-30
Cómo citar
Aguilar, J. L., Sanabra, M., & García, N. (2011). Anestesia Epidural Torácica. Revista Electrónica AnestesiaR, 3(6), 1. https://doi.org/10.30445/rear.v3i6.448
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