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• W2348473819 abstract "Objective To evaluate the influence of epidural block on blood coagulation and rhedogy in patients undergoing esophagectomy or lobectomy. Methods Twenty-two ASA Ⅰ-Ⅱ patients (14 male, 8 female) aged 40-65 yr undergoing esophagectomy or lobectomy were randomized to receive either combined general-epidural anesthesia (GEA group , n = 11) or general anesthesia (GA group, n = 11). The patients were premedicated with intramuscular pethidine 50 mg, promethazine 25 mg and scopolamine 0.3 mg. In GEA group epidural catheter was placed at T9-10 interspace before general anesthesia. A test dose of 4 ml 2% lidocaine was given. When correct positioning of the epidural catheter was confirmed, general anesthesia was induced with propofol 1.5-2.0 mg· kg-1 , fentanyl 2μg·kg-1 and rocuronium 0.6 mg· kg-1 , after placement of double- lumen endobronchial tube the patients were mechanically ventilated (VT 10 ml·kg-1 , RR 12 bpm, I: E = 1:2). Anesthesia was maintained with isoflurane inhalation and intermittent i. v. boluses of vecuronium. A mixture of 2 % lidocaine and 0.33% dicaine (1:1) was continuously infused at a rate of 4-6 ml·h-1 during operation. After operation PCEA was commenced with 0.12% ropivacaine and morphine 80 μg·ml-1 (background infusion 4 ml·h-1 , bolus dose 2 ml, lockout interval 6 min) . In GA group the patients received the same general anesthesia technique. Postoperatively the patients were placed on PCIA with morphine 0.5 mg·ml-1 (background infusion 1 ml·h-1 , bolus dose 2 ml, lockout interval 6 min) Pain intensity was measured using VAS (0-10). Blood samples were taken before induction of anesthesia (T0, baseline), 1 and 3 h after skin incision (T1 , T2 ) and on the morning of 1st and 3rd postoperative day (T3 , T4 ) . Blood samples were tested immediately in a thromboelastograph (TEG) coagulation analyzer. Usual clotting tests (PT, APTT, platelet count, Hb, Hct), fibrinolysis tests (t-PA, PAI-A) and rheology tests were performed at the same time. Results PT and APTT were significantly prolonged during and after operation (T2,T3 ) as compared with the baseline values in both groups (P 0.05 or 0.01) . RBC aggregation and plasma viscosity were significantly decreased during operation (T1 , T2) compared with baseline values (T0) in GEA group (P 0.05) , while there was no significant change in the two variables in GA group. Blood viscosity was significantly decreased in both groups and was significantly lower in GEA group than that in GA group (P 0.05) . Platelet count was significantly decreased while platelet aggregation was significantly increased in GEA group but there was no significant change in platelet count and aggregation in GA group. There were no significant changes in PAI-A in both groups. t-PA increased significantly on the 1st postoperative day in GA group. , The TEG variables : there was no significant change in R- and K time in GEA group while R- and K-time were significantly shortened during and after operation (T2 , T3 , T4) in GA group ( P 0.05) . Alpha angle was significantly increased on the 3rd postoperative day (T4) in both groups (P 0.05). Maximum amplitude (MA) was significantly increased on the 3rd postoperative day (T4 ) in both groups, and the increase was significantly larger in GEA group than that in GA group ( P 0.01) . CL30 and CL60 were significantly increased on the 1 st postoperative day in GEA group as compared with those in GA group ( P 0.05). Conclusion Thoracic epidural anesthesia and PCEA can inhibit increase in coagulation induced by stress, reduce RBC aggregation and blood viscosity and prevent postoperative inhibition of fibrinolysis. However it can improve platelet aggregation." @default.
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• W2348473819 title "Effect of thoracic epidural anesthesia and PCEA on blood coagulation and hemorheology in patients undergoing major thoracic surgery" @default.
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