Document Detail


Sympathetic block during spinal anesthesia in volunteers using lidocaine, tetracaine, and bupivacaine.
MedLine Citation:
PMID:  9223197     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Spinal anesthesia to high thoracic dermatomes is alleged to result in almost complete block of all sympathetic efferent nerves. To examine the degree of sympathectomy during spinal anesthesia, the sympathetic response to a cold pressor test (CPT) applied to unblocked dermatomes before and during spinal anesthesia was measured with use of three different local anesthetics. METHODS: Twelve healthy volunteers were studied in a randomized and double-blind fashion on three separate occasions. In random order, each volunteer received approximately equipotent spinal doses of tetracaine 15 mg, bupivacaine 15 mg, and lidocaine 100 mg in hyperbaric solutions. Prior to and 30 minutes after spinal injection of local anesthetic, a CPT was applied for 2 minutes, and changes from baseline resting conditions in five physiologic variables were measured. RESULTS: The CPT 1 given before anesthetic administration resulted in an increase in heart rate, mean arterial pressure, cardiac index, and plasma concentrations of norepinephrine and epinephrine. Spinal anesthesia to a median level of T3 resulted in a decrease in mean arterial pressure by 10-12% but did not significantly decrease the other variables. Spinal anesthesia did not change the increase in heart rate or cardiac index in response to the second CPT, but the increase in mean arterial pressure was attenuated compared to the CPT before anesthesia. No increase in norepinephrine or epinephrine concentration was observed during the CPT given during spinal anesthesia. There was no significant relationship between level of analgesia and sympathetic response to stress. CONCLUSIONS: Spinal anesthesia with hyperbaric solutions of tetracaine 15 mg, bupivacaine 15 mg, and lidocaine 100 mg attenuated sympathetic function but did not produce complete sympathectomy. The effects were independent of the local anesthetic used.
Authors:
R A Stevens; K Frey; S S Liu; T C Kao; M Mikat-Stevens; D Beardsley; S Holman; J L White
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Regional anesthesia     Volume:  22     ISSN:  0146-521X     ISO Abbreviation:  Reg Anesth     Publication Date:    1997 Jul-Aug
Date Detail:
Created Date:  1997-08-14     Completed Date:  1997-08-14     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7707549     Medline TA:  Reg Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  325-31     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Spinal*
Anesthetics, Local / pharmacology*
Autonomic Nerve Block*
Bupivacaine / pharmacology
Catecholamines / blood
Cold Temperature
Double-Blind Method
Female
Hemodynamics / drug effects
Humans
Lidocaine / pharmacology
Male
Tetracaine / pharmacology
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/Catecholamines; 137-58-6/Lidocaine; 2180-92-9/Bupivacaine; 94-24-6/Tetracaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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