Non-analgesic effects of thoracic epidural anesthesia

Torakal epidural anestezi postoperatif ağrı kontrolünde etkin bir yöntemdir; ayrıca lokal anesteziklerin epidural mesafeye verilmesi ile segmenter sempatik blok meydana gelir. Bu geçici sempatik blokajın kardiyovasküler, solunum ve diğer sistemler üzerine etkileri, postoperatif morbidite ve mortalite üzerine etkileri nedeniyle, araştırılmaya değer gözükmektedir. Torakal epidural anestezi kalp, akciğer ve büyük batın cerrahilerinde başarı ile kullanılmaktadır. Hareket halinde de etkinliği süren bir analjezi ile birlikte erken mobilizasyon, stres yanıtın baskılanması, erken ekstübasyon ve akciğere ait kompllikasyonlarda azalma ve bağarsak işlevinde hızlı derlenme sağlamaktadır. Torakal sempatik blokun en fazla yararlı olacağı düşünülen yer kalp cerrahisidir, ancak yayınlarda morbidite ve mortalite arasında fark saptanmamıştır. Ağrı kontrolündeki başarısına rağmen, torakal epidural anestezinin meta-analizlerde hasta prognozu açısından etkinliği gösterilememiştir. Öte yandan, farklı organ sistemleri üzerine yapılan yakın tarihli çalışmalar halen olumlu etkilerinden söz etmektedir. Torakal epidural anestezi yakın gelecekte daha fazla kullanım alanı bulacak ve tartışmalarla birlikte, üzerinde daha çok çalışılacak gibi durmaktadır.

Torakal epidural anestezinin non-analjezik etkileri

Thoracic epidural anaesthesia is selected usually to provide adequate postoperative analgesia; however with administration of local anaesthetics to epidural space selective sympatolysis ensues. The effects of this transient sympathectomy on cardivascular, respiratory and other systems deserve certainly some interest as it may influence postoperative morbidity or mortality. Thoracic epidural anaesthesia has succesfully been used in cardiac, thoracic and major abdominal surgery. It provides dynamic analgesia, rapid mobilization, blunted stress response, early extubation with reduced pulmonary complications and also rapid recovery of bowel function. In cardiac surgery where thoracic sympathetic blockade is expected to be most useful, there is no difference in morbidity and mortality. Despite the superior quality of pain control, the beneficial aspect of thoracic epidural anaesthesia is not reflected on outcome in meta-analysis. Recent papers has still demonstrated positive effects on each system. So thoracic epidural anaesthesia is increasingly used and it seems that it will be discussed more in near future.

Kaynakça

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