Hemodynamic Effects of Epidural Analgesia for Gastrectomy in the Geriatric Patient

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.