[Hypotensive epidural anesthesia in thoracic surgery].

Objective: This study evaluated effectiveness of hypotensive epidural anesthesia in decreasing blood loss, operation and extubation time, opiates use and stay in intensive care unit.

Material And Methods: Fifty-eight patients were enrolled in the study. Right (n=16) or left (n=42) pneumectomy was performed for the study patients. We used the hypotensive anesthesia induced by thoracic epidural anesthesia for the group T (n=29/50%) and normotensive anesthesia for the group K (n=29/50%). The epidural catheter was introduced into the epidural space at the level Th4-5. Arterial pressure was reduced using bupivacaine into epidural space. In the group T median arterial pressure was about 50-60 mmHg. For the group K we used only general anesthesia and median arterial pressure was 80-120 mmHg.

Results: The average intra-operative blood loss was 534+/-198 ml in the group T and 1287+/-380 ml in the group K (p<0.001). Post-operative blood loss was the same in both groups. The average operation time was 10% shorter in the group T (p=0.078). Fentanyl use in the T group was 203+/-91 microg and 1266+/-601 microg in the K group (p<0.001). Patients in the T group were safely extubated after 66+/-17 min (p<0.001) and discharged from intensive care unit after 2+/-1.1 days (p<0.05). The patients in the group K were extubated after 138+/-37 min and discharged from intensive care unit after 3.27+/-1.3 days.

Conclusion: Hypotensive epidural anesthesia is an effective method to decrease blood loss and blood transfusions in thoracic surgery. It creates better conditions for surgery and reduces stay in intensive care unit. Also there were no serious cardiac, neurological and renal intra-operative and post-operative complications that could be conditioned by the use of hypotension.