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The hemodynamic effect of epidural analgesia supplemented with a small dose of sedatives was studied by Swan-Ganz Catheter method in fifteen geriatric patients from 65 to 80 years old with gastrectomy. No premedication was given to avoid its circulatory effects. From one venous route 5 ml/kg/hr of lactated Ringer solution and from the other hydroxyethyl starch at the same rate were infused. Epidural puncture was performed in the intervertebral space between T_8 and T_<10> and 6 to 8 ml of 2% mepivacaine were administered through the epidural catheter. Analgesia by epidural block 20 min later was in average from T_2 to L_1. Hemodynamic parameters were assessed before, 20 min after epidural block, and 5 and 20 min after diazepam (5mg). After 20 min of epidural analgesia, HR (-5%), MAP (-19%), SVR (-16%), and RPP (-28%) decreased significantly, while MPAP, CVP, CI, SVI and PVR did not change. Five minutes after diazepam, hemodynamic parameters decreased by 10% more. These changes, however, returned to the pre-administration level 20 min after diazepam. Though meticulous caution is needed for intraoperative management from a circulatory and respiratory standpoint, we consider epidural analgesia to be one of the recommendable anesthetic methods for the anesthesia of gastrectomy in elderly patients.
Shimane journal of medical science
Shimane Medical University
Departmental Bulletin Paper
Faculty of Medicine