In the supplement issue published in September/October 2016, Abstracts and Highlight Papers of the 35th Annual European Society of Regional Anaesthesia & Pain Therapy (ESRA) Congress 2016, the following abstract was not included.
CENTRAL NERVE BLOCKS 1
EPIDURAL ANAESTHESIA FOR PERCUTANEOUS NEPHROLITHOTOMY IN THE PRONE POSITION – THE EVALUATION OF CARDIAC INDEX
L. Jureczko1, K. Dobronska1, M. Kolacz1, P. Dobronski2
1 Medical University of Warsaw, I Department of Aneasthesia and Intensive Care, Warszawa, Poland
2 Medical University of Warsaw, Chair and Department of Urology, Warszawa, Poland
Background and Aims:
Percutaneous nephrolithotomy (PNL) is a renal lithiasis endoscopic treatment. It usually begins in the lithotomy position for ureteral catheter placement and retrograde pyelography and, subsequently, an optimal renal access is obtained in the prone position. Performing epidural anaesthesia for PNL avoids the complications associated with putting prone an intubated, muscle-relaxed, unconscious patient and the reduction of the motor block gives the patient the possibility to change the position unaided. Clinical observations during the procedure prove that some patients present a cardiac insufficiency: dyspnea, bradycardia and hypotension. This may be related to changes occurring within the circulatory system. The aim of this prospective, randomised, double-blind study was to evaluate the changes of the cardiac index (CI).
In a group of 50 patients, ASA 1–2, an epidural anaesthesia with either 0.2% ropivacaine or 0.25% bupivacaine was performed and then the CI was evaluated by impedance cardiography.
45 patients were included in the analysis; all tolerated the PNL well. After turning prone, a decrease in the CI was recorded irrespective of the type of local anaesthetic used. There was a significant variability of recorded values. The average CI dropped from 2.96 l/min/m2 (0.42 SD) to 2.28 l/min/m2 (0.39 SD). In 7 patients the decrease was greater than 35%. No correlation was observed with the arterial blood pressure or the heart rate.
In all patients having the PNL under epidural anaesthesia, the change from the lithotomy to the prone position resulted in the CI decrease. The patients ASA 1–2 compensate the drop well.
1. Abstracts and Highlight Papers of the 35th Annual European Society of Regional Anaesthesia & Pain Therapy (ESRA) Congress 2016. Reg Anesth Pain Med