Effect of Thoracic Epidural Anesthesia on Left Ventricular Functions: a Strain Echocardiography Study

NCT06770790 | Not Yet Recruiting DMC

• 1 other identifier: 199
• Study Type: observational
• Target: 23
• Locations: 0 countries
• Sites: N/A

Brief Summary

Post-thoracic surgery pain management thoracic epidural catheter is the most commonly used method. Thoracic epidural anesthesia, in which cardiac sympathetic nerves (T1-T5) are involved in neural blockade, is the focus of our research. Many studies have shown a decrease in inotropic status (intrinsic function) after blockade of cardiac sympathetic innervation with thoracic epidural anesthesia (TEA).We want to examine the cardiac effects of TEA with strain echocardiography, which is an advanced echocardiography method. Therefore, we aimed to investigate the effect of TEA on left ventricular functions with strain echocardiography.

Conditions

Thoracal Epidural Block; Echocardiography

Keywords

thoracic epidural anesthesia; left ventricle; strain echocardiography; cardiac function

Outcome Measures

Primary Outcomes (1)

• Echocardiographic assessment of left ventricular function

  Description: Standard measurements of left ventricular systolic function include left ventricular volumes (indexed to body surface area, BSA), left ventricular ejection fraction (LVEF) according to the modified Simpson rule, time and velocity integral in the left ventricular outflow tract (TVI-LVOT), and stroke volume (SV) (= π x LVOT radius2 x TVI-LVOT). Stroke volume index (SVI) will be calculated as SV/BSA. Mitral and aortic Doppler flow profiles, left ventricular isovolumetric relaxation time, and maximum flow velocity measurements will be recorded. LV early (E-max) and late (A-max) diastolic filling will be assessed.

  Left ventricular function will be assessed by echocardiography 15 minutes before and 15 minutes after high TEA.

Study Arms (1)

thoracal epidural anesthesia

After appropriate local anesthesia, the patient will be placed in the epidural area while in a sitting position. The puncture will be performed between t6-t7 and t8-t9 with a midline approach with a "loss of resistance" specialist. The catheter is inserted into the epidural space 3-4 cm and the epidural lidocaine bolus (10 ml at 2% capacity) while the pain is in the supine region.

Other: strain echocardiography

Interventions

strain echocardiography OTHER

HR, MAP, SBP, and DBP will be recorded at baseline and 15 minutes after ESP block. Cardiac output (CO) will be calculated using echocardiographic data on stroke volume (SV) (measured from the LV outflow tract) and multiplied by HR. Two transthoracic 2D echocardiographic examinations will be performed immediately before and 15 minutes after TEA. The examinations include apical four-, two-, and three-chamber projections, mitral and aortic Doppler flow velocities. Standard measurements of left ventricular systolic function include left ventricular volumes (indexed to body surface area, BSA), left ventricular ejection fraction (LVEF) according to the modified Simpson rule, time and velocity integral in the left ventricular outflow tract (TVI-LVOT), and stroke volume (SV) (= π x LVOT radius2 x TVI-LVOT). Stroke volume index (SVI) will be calculated as SV/BSA. Mitral and aortic Doppler flow profiles, left ventricular isovolumetric relaxation time, maximum flow velocity will be recorded for m

thoracal epidural anesthesia

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients who will have a thoracic epidural catheter inserted for thoracic surgery and are between the ages of 18-75 and in the ASA1-3 group.

You may qualify if:

• Elective payment options ASA I-III Ages 18-75

You may not qualify if:

• Refusal at enrollment
• Request for withdrawal from the study
• Inability to give informed consent
• Emergency surgery
• Bleeding diathesis
• Presence of contraindications to the LA agents used in this study
• Use of chronic opioids
• Psychiatric disorders
• Presence of infection at the injection site

Sponsors & Collaborators

• Aydin Adnan Menderes University: lead

Related Publications (1)

• Rex S, Missant C, Segers P, Wouters PF. Thoracic epidural anesthesia impairs the hemodynamic response to acute pulmonary hypertension by deteriorating right ventricular-pulmonary arterial coupling. Crit Care Med. 2007 Jan;35(1):222-9. doi: 10.1097/01.CCM.0000250357.35250.A2.

  PMID: 17095942 BACKGROUND

Central Study Contacts

ferdi gülaştı

CONTACT

+905054929650; ferdigulasti@gmail.com

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Target Duration: 1 Day
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: asst.prof.dr

Study Record Dates

• First Submitted: December 27, 2024
• First Posted: January 13, 2025
• Study Start: January 10, 2025
• Primary Completion: January 5, 2026
• Study Completion: February 5, 2026
• Last Updated: January 13, 2025

Record last verified: 2024-12