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Influences of Spinal Anesthesia on Exercise Tolerance in Patients with COPD.
MedLine Citation:
PMID:  22822019     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE: Lower limb muscle dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). We hypothesized that signaling from lower limb muscle group III/IV sensory afferents to the central motor command could be involved in premature cycling exercise termination in COPD. OBJECTIVES: To evaluate the effects of spinal anesthesia which presumably inhibited central feedback from the lower limb muscle group III/IV sensory afferents on exercise tolerance and cardiorespiratory response during constant workrate cycling exercise in patients with COPD. METHODS: In a cross-over and double-blind randomized design, 8 patients with COPD (FEV1 = 67 ± 8 % predicted) completed a constant workrate cycling exercise following either sham (NaCl, interspinous L3-L4) or active (fentanyl 25 µg, intrathecal L3-L4) spinal anesthesia. MEASUREMENTS AND MAIN RESULTS: When compared with placebo, endurance time was significantly prolonged following spinal anesthesia with fentanyl (639 ± 87 sec vs. 423 ± 38 sec, p = 0.01, mean ± SEM). Ventilation and respiratory rate were reduced at isotime points under the fentanyl condition while ventilatory efficiency and dead space ventilation were improved. Patients exhibited less dynamic hyperinflation at isotime points with spinal anesthesia. Consequently, the rise in dyspnea was significantly flatter during the fentanyl condition than with placebo. CONCLUSIONS: Spinal anesthesia enhanced cycling exercise tolerance in patients with COPD, mostly by reducing ventilatory response and dyspnea during exercise; these effects were possibly mediated through the inhibition of group III/IV lower limb sensory muscle afferents.
Authors:
Philippe Gagnon; Jean S Bussières; Fernanda Ribeiro; Serge L Gagnon; Didier Saey; Nathalie Gagné; Steeve Provencher; François Maltais
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-19
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
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