Management of Regional Anesthesia

  • Bernadette Veering


There has been a dramatic increase in the elderly population throughout the past century. In one century, the number of persons aged 65 years or older has increased three times. Patients aged 85 and older are the most rapidly growing age group. By 2030, up to 20% of Western populations will be more than 65 years of age.1 This situation has led to a progressive increase in the number of surgical interventions in elderly people. It has been estimated that more than half of the population older than 65 years will require surgical intervention at least once during the remainder of their lives.2


Spinal Anesthesia Epidural Analgesia Regional Anesthesia Epidural Anesthesia Motor Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    US Bureau of Census. Statistical Abstracts of the United States. 113th ed. Washington, DC: Department of Commerce; 1993.Google Scholar
  2. 2.
    Klopfenstein CE, Herrmann FR, Michel JP, et al. The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesth Analg 1998;86:1165–1170.PubMedCrossRefGoogle Scholar
  3. 3.
    Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders; 1978:31–35.Google Scholar
  4. 4.
    Ferrer-Brechner T. Spinal and epidural anaesthesia in the elderly. Semin Anesth 1986;V:54–61.Google Scholar
  5. 5.
    Jacob JM, Love S. Qualitative and quantitative morphology of human sural nerve at different ages. Brain 1985; 108:897–924.CrossRefGoogle Scholar
  6. 6.
    Dorfman LJ, Bosley TM. Age related changes in peripheral and central nerve conduction in man. Neurology 1979;29: 38–44.PubMedGoogle Scholar
  7. 7.
    Shanta TR, Evans JA. The relationship of epidural anesthesia to neural membranes and arachnoid villi. Anesthesiology 1972;37:543–557.Google Scholar
  8. 8.
    May C, Kaye JA, Atack JR, et al. Cerebrospinal fluid production is reduced in healthy aging. Neurology 1990;40: 500–503.PubMedGoogle Scholar
  9. 9.
    Greene NM. Physiology of Spinal Anaesthesia. 3rd ed. Baltimore: Williams & Wilkins; 1981:5.Google Scholar
  10. 10.
    Park WY, Balingit PE, MacNamara TE. Age and the epidural dose response in adult man. Anesthesiology 1982;56: 318–332.PubMedCrossRefGoogle Scholar
  11. 11.
    Veering BT, Burm AGL, Van Kleef JW, et al. Epidural anesthesia with bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesth Analg 1987;66: 589–594.PubMedGoogle Scholar
  12. 12.
    Veering BT, Burm AGL, Vletter AA, et al. The effect of age on the systemic absorption and systemic disposition of bupivacaine after epidural administration. Clin Pharmacokinet 1992;22:75–84.PubMedGoogle Scholar
  13. 13.
    Nydahl PA, Philipson L, Axelsson K, et al. Epidural anesthesia with 0.5% bupivacaine: influence of age on sensory and motor blockade. Anesth Analg 1991;73:780–787.PubMedCrossRefGoogle Scholar
  14. 14.
    Hirabayashi Y, Shimizu R. Effect of age on extradural dose requirement in thoracic extradural anaesthesia. Br J Anaesth 1993;71:445–446.PubMedCrossRefGoogle Scholar
  15. 15.
    Simon MJ, Veering BT, Stienstra R, et al. The effects of age on neural blockade and hemodynamic changes after epidural anesthesia with ropivacaine. Anesth Analg 2002;94: 1325–1330.PubMedCrossRefGoogle Scholar
  16. 16.
    Simon MJG, Veering BT, Burm AGL, et al. The effect of age on the clinical profile and the systemic absorption and disposition of levobupivacaine following epidural anaesthesia. Br J Anaesth 2004;93:512–520.PubMedCrossRefGoogle Scholar
  17. 17.
    Hirabayashi Y, Shimizu R, Matsuda J, et al. Effect of extradural compliance and resistance on spread of extradural analgesia. Br J Anaesth 1990;65:508–513.PubMedCrossRefGoogle Scholar
  18. 18.
    Bromage PR. Exaggerated spread of epidural analgesia in arteriosclerotic patients. Dosage in relation to biological and chronological ageing. Br Med J 1962;2:1634–1638.PubMedCrossRefGoogle Scholar
  19. 19.
    Guinard JP, Mulroy MF, Carpenter RL. Aging reduces the reliability of epidural epinephrine test doses. Reg Anesth 1995;20:193–198.PubMedGoogle Scholar
  20. 20.
    Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 2000;92:433–441.PubMedCrossRefGoogle Scholar
  21. 21.
    Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 1987;240:159–166.PubMedGoogle Scholar
  22. 22.
    Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth 2001;87:608–624.PubMedCrossRefGoogle Scholar
  23. 23.
    Pitkänen M, Haapaniemi L, Tuominen M, et al. Influence of age on spinal anaesthesia with isobaric 0.5% bupivacaine. Br J Anaesth 1984;56:279–284.PubMedCrossRefGoogle Scholar
  24. 24.
    Veering BT, Burm AGL, Van Kleef JW, et al. Spinal anesthesia with glucose-free bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesth Analg 1987;66:965–970.PubMedGoogle Scholar
  25. 25.
    Boss EG, Schuh FT. Der Einfluss des Lebensalters auf die Ausbreitung der Spinalanasthesie mit isobarem Mepivacain 2%. Anaesthesist 1993;42:162–168.PubMedGoogle Scholar
  26. 26.
    Veering BT, Burm AGL, Spierdijk J. Spinal anaesthesia with hyperbaric bupivacaine: effects of age on neural blockade and pharmacokinetics. Br J Anaesth 1988;60: 187–194.PubMedCrossRefGoogle Scholar
  27. 27.
    Racle JP, Benkhadra A, Poy JY, et al. Spinal analgesia with hyperbaric bupivacaine: influence of age. Br J Anaesth 1988;60:508–514.PubMedCrossRefGoogle Scholar
  28. 28.
    Veering BT, Burm AGL, Vletter AA, et al. The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration. Anesthesiology 1991;74:250–257.PubMedCrossRefGoogle Scholar
  29. 29.
    Racle JP, Benkhadra A, Poy JY, et al. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg 1987; 66:442–446.PubMedGoogle Scholar
  30. 30.
    Racle JP, Benkhadra A, Poy JY, et al. Effects of increasing amounts of epinephrine during isobaric bupivacaine spinal anesthesia in elderly patients. Anesth Analg 1987;66: 882–886.PubMedGoogle Scholar
  31. 31.
    Paqueron X, Boccara G, Bendahou M, et al. Brachial plexus nerve block exhibits prolonged duration in the elderly. Anesthesiology 2002;97:1245–1249.PubMedCrossRefGoogle Scholar
  32. 32.
    Tucker GT. Pharmacokinetics of local anaesthetics. Br J Anaesth 1986;58:717–731.PubMedCrossRefGoogle Scholar
  33. 33.
    Freund PR, Bowdle TA, Slattery JT, et al. Caudal anesthesia with lidocaine or bupivacaine: plasma local anaesthetic concentration and extent of sensory spread in old and young patients. Anesth Analg 1984;63:1017–1020.PubMedCrossRefGoogle Scholar
  34. 34.
    Bowdle TA, Freund PR, Slattery JT. Age dependent lidocaine pharmacokinetics during lumbar peridural anesthesia with lidocaine hydrocarbonate or lidocaine hydrochloride. Reg Anesth 1986;11:123–127.Google Scholar
  35. 35.
    Finucane BT, Hammonds WD, Welch MB. Influence of age on vascular absorption of lidocaine from the epidural space. Anesth Analg 1987;66:843–846.PubMedCrossRefGoogle Scholar
  36. 36.
    Burm AGL, Vermeulen NPE, VanKleef JW, et al. Pharmacokinetics of lignocaine and bupivacaine in surgical patients following epidural administration. Simultaneous investigation of absorption and disposition kinetics using stable isotopes. Clin Pharmacokinet 1987;13:191–203.PubMedGoogle Scholar
  37. 37.
    Burm AGL, VanKleef JW, Vermeulen NPE, et al. Pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration in surgical patients: simultaneous investigation of absorption and disposition kinetics using stable isotopes. Anesthesiology 1988;69:584–592.PubMedCrossRefGoogle Scholar
  38. 38.
    Emanuelsson BMK, Persson J, Alm C, et al. Systemic absorption and block after epidural injection of ropivacaine in healthy volunteers. Anesthesiology 1997;87:1309–1317.PubMedCrossRefGoogle Scholar
  39. 39.
    Greenblatt DJ, Sellers EM, Shader RI. Drug disposition in old age. New Engl J Med 1982;306:1081–1108.PubMedGoogle Scholar
  40. 40.
    Nation RL, Triggs EJ, Selig M. Lignocaine kinetics in cardiac patients and aged subjects. Br J Clin Pharmacol 1977;4:439–448.PubMedGoogle Scholar
  41. 41.
    Cusson J, Nattel S, Matthews C, et al. Age-dependent lignocaine disposition in patients with acute myocardial infarction. Clin Pharmacol Ther 1985;37:381–386.PubMedGoogle Scholar
  42. 42.
    Cussack B, O’Malley K, Lavan J, et al. Protein binding and disposition of lignocaine in the elderly. Eur J Clin Pharmacol 1985;29:923–929.CrossRefGoogle Scholar
  43. 43.
    Tucker GT, Boyes RN, Bridenbaugh PO, et al. Binding of anilide-type local anesthetics in human plasma. I. Relationships between binding, physicochemical properties and anesthetic activity. Anesthesiology 1970;33:287–303.PubMedGoogle Scholar
  44. 44.
    Davis D, Grossman SH, Kitchell BB, et al. The effects of age and smoking on the plasma binding of lignocaine and diazepam. Br J Clin Pharmacol 1985;19:261–265.PubMedGoogle Scholar
  45. 45.
    Veering BT, Burm AGL, Gladines MPRR, et al. Age does not influence the serum protein binding of bupivacaine. Br J Clin Pharmacol 1991;32:501–503.PubMedGoogle Scholar
  46. 46.
    Veering BT, Burm AGL, Souverijn JHM, et al. The effect of age on serum concentrations of albumin and ß1-acid glycoprotein. Br J Clin Pharmacol 1990;29:201–206.PubMedGoogle Scholar
  47. 47.
    Mather LE, Thomas J. Bupivacaine binding to plasma protein fractions. J Pharm Pharmacol 1978;30:653–654.PubMedGoogle Scholar
  48. 48.
    Tucker GT. Is plasma binding of local anesthetics important? Acta Anaesthesiol Belg 1988;39:147–150.PubMedGoogle Scholar
  49. 49.
    Tucker GT, Wiklund L, Berlin-Wahlen A, et al. Hepatic clearance of local anesthetics in man. J Pharmacokinet Biopharm 1977;5:11–22.CrossRefGoogle Scholar
  50. 50.
    Wilkinson GR, Shand DG. A physiological approach to hepatic drug clearance. Clin Pharmacol Ther 1975;18: 377–390.PubMedGoogle Scholar
  51. 51.
    Abernethy DR, Greenblatt DJ. Impairment of lidocaine clearance in elderly male subjects. J Cardiovasc Pharmacol 1983;5:1093–1096.PubMedCrossRefGoogle Scholar
  52. 52.
    Wynne HA, Cope LH, Mutch E, et al. The effect of age upon liver volume and apparent liver blood flow in healthy man. Hepatology 1989;9:297–301.PubMedCrossRefGoogle Scholar
  53. 53.
    Ross RA, Clarke JE, Armitage EN. Postoperative pain prevention by continuous epidural infusion. Anaesthesia 1980;35:663–668.PubMedCrossRefGoogle Scholar
  54. 54.
    Veering BT, Burm AGL, Feyen MH, et al. Pharmacokinetics of bupivacaine during postoperative epidural infusion: enantioselectivity and role of protein binding. Anesthesiology 2002;96:1062–1069.PubMedCrossRefGoogle Scholar
  55. 55.
    Aronson KF, Ekelund G, Kindmark CO, et al. Sequential changes of plasma proteins after surgical trauma. Scand J Clin Lab Invest 1972;29(Suppl 124):127–136.CrossRefGoogle Scholar
  56. 56.
    Fukuda T, Kakiuchi Y, Masayuki M, et al. Free lidocaine concentrations during continuous epidural anesthesia in geriatric patients. Reg Anesth Pain Med 2003;28:215–220.PubMedCrossRefGoogle Scholar
  57. 57.
    Gielen M. Post dural puncture headache (PDPH): a review. Reg Anesth 1989;14:101–106.PubMedGoogle Scholar
  58. 58.
    Veering BT, Cousins MJ. Cardiovascular and pulmonary effects of epidural anaesthesia. Anaesth Intensive Care 2000;28:620–635.PubMedGoogle Scholar
  59. 59.
    Tarkkila P, Isola J. A regression model for identifying patients at high risk of hypotension, bradycardia and nausea during spinal anesthesia. Acta Anaesthesiol Scand 1992;36:554–558.PubMedGoogle Scholar
  60. 60.
    Carpenter RL, Caplan RA, Brown DL, et al. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76:906–912.PubMedCrossRefGoogle Scholar
  61. 61.
    Juelsgaard P, Sand NP, Felsby S, et al. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. Eur J Anaesthesiol 1998;15: 656–663.PubMedCrossRefGoogle Scholar
  62. 62.
    Racle JP, Poy JY, Haberer JP, et al. A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. Reg Anesth 1989;14:66–71.PubMedGoogle Scholar
  63. 63.
    Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth 2000;85:763–778.PubMedCrossRefGoogle Scholar
  64. 64.
    Rooke GA. Cardiovascular aging and anesthetic implications. J Cardiothorac Vasc Anesth 2003;17:512–523.PubMedCrossRefGoogle Scholar
  65. 65.
    Korkuschko OW, Sarkisow KG, Schatilo WB, et al. Hemodynamic effects of stimulation of alpha 1-adrenoreceptors in healthy elderly and aged persons. Z Gerontol 1992;25: 88–93.PubMedGoogle Scholar
  66. 66.
    Veith RC, Featherstone JA, Linares OA, et al. Age differences in plasma norepinephrine kinetics in humans. J Gerontol 1986;41:319–324.PubMedGoogle Scholar
  67. 67.
    Ebert TJ, Morgan BJ, Barney JA, et al. Effects of aging on baroreflex regulation of sympathetic activity in humans. Am J Physiol 1992;263:H789–803.Google Scholar
  68. 68.
    Rooke GA, Freund PR, Jacobsen AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with heart disease. Anesth Analg 1997;85:99–105.PubMedCrossRefGoogle Scholar
  69. 69.
    Critchley LAH, Stuart JC, Short TG, et al. Haemodynamic effects of subarachnoid block in elderly patients. Br J Anaesth 1994;73:464–470.PubMedCrossRefGoogle Scholar
  70. 70.
    Coe AJ, Revanas B. Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia 1990;45: 241–243.PubMedCrossRefGoogle Scholar
  71. 71.
    Buggy DJ, Power CK, Meeke R, et al. Prevention of spinal anaesthesia-induced hypotension in the elderly: i.m. methoxamine or combined hetastarch and crystalloid. Br J Anaesth 1998;80:199–203.PubMedGoogle Scholar
  72. 72.
    Critchley LAH. Hypotension, subarachnoid block and the elderly patient. Anaesthesia 1996;51:1139–1143.PubMedCrossRefGoogle Scholar
  73. 73.
    Critchley LA, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth 1994;72:151–155.PubMedCrossRefGoogle Scholar
  74. 74.
    Critchley LA, Conway F. Hypotension during subarachnoid anaesthesia: haemodynamic effects of colloid and metaraminol. Br J Anaesth 1996;76:734–736.PubMedGoogle Scholar
  75. 75.
    Chamberlain D, Chamberlain B. Changes in skin temperature of the trunk and their relationship to sympathetic block during spinal anesthesia. Anesthesiology 1986;65: 139–143.PubMedCrossRefGoogle Scholar
  76. 76.
    Ben-David B, Frankel R, Arzumonov T, et al. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000;92:6–10.PubMedCrossRefGoogle Scholar
  77. 77.
    Veering BT, Ter Riet PM, Burm AGL, et al. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effect of site of injection on spread of analgesia. Br J Anaesth 1996;77:343–346.PubMedGoogle Scholar
  78. 78.
    Veering BT, Immink-Speet TTM, Burm AGL, et al. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effects of duration spent in the sitting position. Br J Anaesth 2001;87:738–742.PubMedCrossRefGoogle Scholar
  79. 79.
    Sumi M, Sakura S, Koshizaki M, et al. The advantages of the lateral decubitus position after spinal anesthesia with hyperbaric tetracaine. Anesth Analg 1998;87:879–884.PubMedCrossRefGoogle Scholar
  80. 80.
    Favarel-Garrigues JF, Sztark F, Petitjan ME, et al. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg 1996;82:312–316.PubMedCrossRefGoogle Scholar
  81. 81.
    Frank SM, Beattie C, Christopherson R, et al. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology 1992;77:252–257.PubMedCrossRefGoogle Scholar
  82. 82.
    Wagner JA, Robinson S, Marinao RP. Age and temperature regulation of humans in neutral and cold environments. J Appl Physiol 1974;37:562–565.PubMedGoogle Scholar
  83. 83.
    Frank SM, El-Rahmany HK, Cattaneo CG, et al. Predictors of hypothermia during spinal anesthesia. Anesthesiology 2000;92:1330–1334.PubMedCrossRefGoogle Scholar
  84. 84.
    Leslie K, Sessler DI. Reduction in the shivering threshold is proportional to spinal block height. Anesthesiology 1996;84:1327–1331.PubMedCrossRefGoogle Scholar
  85. 85.
    Vassilieff N, Rosencher N, Sessler DI, et al. Shivering threshold during spinal anesthesia is reduced in elderly patients. Anesthesiology 1995;83:1162–1166.PubMedCrossRefGoogle Scholar
  86. 86.
    Bell GD, Reeve PA, Moshiri M, et al. Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient. Br J Clin Pharmacol 1987;23:241–243.PubMedGoogle Scholar
  87. 87.
    Schnider TW, Minto CF, Shafer SL, et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90:1502–1516.PubMedCrossRefGoogle Scholar
  88. 88.
    Shinozaki M, Usui Y, Yamaguchi S, et al. Recovery of psychomotor function after propofol sedation is prolonged in the elderly. Can J Anaesth 2002;49:927–931.PubMedGoogle Scholar
  89. 89.
    Wu CL, Hsu W, Richman JM, et al. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth Pain Med 2004;29:257–268.PubMedCrossRefGoogle Scholar
  90. 90.
    Gustafson Y, Beggren D, Banstöm B, et al. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc 1988;36:525–530.PubMedGoogle Scholar
  91. 91.
    Williams-Russo P, Urquhart RN, Sharrock NE, et al. Postoperative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992;40:759–767.PubMedGoogle Scholar
  92. 92.
    Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly. ISPOCD1 study. IOPOCD investigators. International Study of Post Operative Cognitive Dysfunction. Lancet 1998;351:857–861.PubMedCrossRefGoogle Scholar
  93. 93.
    Canet J, Raeder J, Rasmussen LS, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 2003;47:1204–1210.PubMedCrossRefGoogle Scholar
  94. 94.
    Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 1995;82:1474–1506.PubMedCrossRefGoogle Scholar
  95. 95.
    Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth 1989;63:189–195.PubMedCrossRefGoogle Scholar
  96. 96.
    Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87:62–72.PubMedCrossRefGoogle Scholar
  97. 97.
    Rosenfeld BA. Benefits of regional anaesthesia on thrombo-embolic complications following surgery. Reg Anesth 1996;21:S9–S12.Google Scholar
  98. 98.
    Donadoni R, Baele G, Devulder J, et al. Coagulation and fibrinolytic parameters in patients undergoing total hip replacement: influence of anaesthesia technique. Acta Anaesthesiol Scand 1989;33:588–592.PubMedGoogle Scholar
  99. 99.
    Rosenfeld BA, Beattie C, Christopherson R, et al. The Perioperative Ischaemia Randomized Anesthesia Trial Study Group: the effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 1993;79:435–443.PubMedCrossRefGoogle Scholar
  100. 100.
    Wu CL, Caldwell MD. Effect of post-operative analgesia on patient morbidity. Best Pract Res Clin Anaesthesiol 2002;16:549–563.PubMedCrossRefGoogle Scholar
  101. 101.
    Davis FM, McDermott E, Hickton C, et al. Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty. Br J Anaesth 1987;59:561–571.PubMedCrossRefGoogle Scholar
  102. 102.
    Valentin N, Lomholt B, Jensen JS, et al. Spinal or general anaesthesia for surgery of the fractured hip? Br J Anaesth 1986;58:284–291.PubMedCrossRefGoogle Scholar
  103. 103.
    Lundh R, Hedenstierna G, Johansson H. Ventilationperfusion relationships during epidural analgesia. Acta Anaesthesiol Scand 1983;27:410–416.PubMedGoogle Scholar
  104. 104.
    McKenzie PJ, Wishart HY, Dewar KMS, et al. Comparison of the effects of spinal anaesthesia and general anaesthesia on postoperative oxygenation and perioperative mortality. Br J Anaesth 1980;52:49–55.PubMedCrossRefGoogle Scholar
  105. 105.
    Catley D, Thornton C, Jordan C, et al. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology 1985;63:20–28.PubMedCrossRefGoogle Scholar
  106. 106.
    Klassen GA, Bramwell RS, Bromage PR, et al. The effect of acute sympathectomy by epidural anesthesia on the canine coronary circulation. Anesthesiology 1980;52: 8–15.PubMedCrossRefGoogle Scholar
  107. 107.
    Davis RF, De Boer LWV, Maroko PR. Thoracic epidural anesthesia reduces myocardial infarct size after coronary artery occlusion in dogs. Anesth Analg 1986;65:711–717.PubMedCrossRefGoogle Scholar
  108. 108.
    Blomberg S, Curelaru J, Emanuelsson H, et al. Thoracic epidural anaesthesia in patients with unstable angina pectoris. Eur Heart J 1989;10:437–444.PubMedGoogle Scholar
  109. 109.
    Blomberg S, Emanuelsson H, Kvirst H, et al. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 1990;73:840–847.PubMedCrossRefGoogle Scholar
  110. 110.
    Blomberg S, Emanuelsson H, Ricksten SE. Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris. Anesth Analg 1989;69:558–562.PubMedCrossRefGoogle Scholar
  111. 111.
    Kock M, Blomberg S, Emanuelsson H, et al. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Anesth Analg 1990;71:625–630.PubMedCrossRefGoogle Scholar
  112. 112.
    Meissner A, Rolf N, Van Aken H. Thoracic epidural anesthesia and the patient with heart disease: benefits, risks and controversies. Anesth Analg 1997;85:517–528.PubMedCrossRefGoogle Scholar
  113. 113.
    Ford G, Whitelaw W, Rosenal T, et al. Diaphragm function after upper abdominal surgery in humans. Am Rev Respir Dis 1987;127:431–436.Google Scholar
  114. 114.
    Pansard JL, Mankikian B, Bertrand M, et al. Effects of thoracic extradural block on diaphragmatic electrical activity and contractility after upper abdominal surgery. Anesthesiology 1993;78:63–71.PubMedCrossRefGoogle Scholar
  115. 115.
    Polaner DM, Kimball WR, Fratacci M, et al. Thoracic epidural anesthesia increases diaphragmatic shortening after thoracotomy in the awake lamb. Anesthesiology 1993;79:808–816.PubMedCrossRefGoogle Scholar
  116. 116.
    Steinbrook RA. Epidural anesthesia and gastrointestinal motility. Anesth Analg 1998;86:837–844.PubMedCrossRefGoogle Scholar
  117. 117.
    Lehman JF, Wiseman JS. The effect of epidural analgesia on the return of peristalsis and the length of stay after elective colonic surgery. Am Surg 1995;61:1009–1012.PubMedGoogle Scholar
  118. 118.
    Adolphs J, Schmidt DK, Mousa SA, et al. Thoracic epidural anesthesia attenuates hemorrhage-induced impairment of intestinal perfusion in rats. Anesthesiology 2003;99:685–692.PubMedCrossRefGoogle Scholar
  119. 119.
    O’Hara DA, Duff A, Berlin JA, et al. The effect of anesthetic technique on postoperative outcomes of hip fracture repair. Anesthesiology 2000;92:947–957.PubMedCrossRefGoogle Scholar
  120. 120.
    Sutcliffe AJ. Mortality after spinal and general anaesthesia for surgical fixation of hip fractures. Anaesthesia 1994; 49:237–240.PubMedGoogle Scholar
  121. 121.
    Pedersen T, Moller A, Cracknell J. The mission of the Cochrane Anesthesia Review Group: preparing and disseminating systematic reviews of the effect of health care in anesthesiology. Anesth Analg 2002;95:1012–1018.PubMedCrossRefGoogle Scholar
  122. 122.
    Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip-fracture surgery: meta-analysis of randomized trials. Br J Anaesth 2000;84:450–455.PubMedGoogle Scholar
  123. 123.
    Gilbert TB, Hawkes WG, Hebel JR, et al. Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up. Am J Orthop 2000;29:25–35.PubMedCrossRefGoogle Scholar
  124. 124.
    Bode RH, Lewis PL, Zarich SW, et al. Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology 1996;84:3–13.PubMedCrossRefGoogle Scholar
  125. 125.
    Tuman KJ, McCarthy RJ, Marck RJ, et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 1991;73:696–704.PubMedCrossRefGoogle Scholar
  126. 126.
    Christopherson R, Beattie C, Meinert CL, et al. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology 1993;79:422–434.PubMedCrossRefGoogle Scholar
  127. 127.
    Park WY, Thompson JS, Lee KK. Effect on epidural anesthesia and analgesia on perioperative outcome. A randomized, controlled veterans affairs cooperative study. Ann Surg 2001;234(4):560–571.PubMedCrossRefGoogle Scholar
  128. 128.
    Beattie SW, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a metaanalysis. Anesth Analg 2001;93:853–858.PubMedCrossRefGoogle Scholar
  129. 129.
    Matot I, Oppenheim-Eden A, Ratrot R, et al. Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology 2003;98:156–163.PubMedCrossRefGoogle Scholar
  130. 130.
    Modig J, Borg T, Karlström G, et al. Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg 1983;62:174–180.PubMedCrossRefGoogle Scholar
  131. 131.
    Modig J, Borg T, Bagge L, et al. Role of extradural and of general anaesthesia in fibrinolysis and coagulation after total hip replacement. Br J Anaesth 1983;55:625–629.PubMedCrossRefGoogle Scholar
  132. 132.
    Modig J, Borg T, Karlström G, et al. Effect of epidural versus general anaesthesia on calf blood flow. Acta Anaesthesiol Scand 1980;24:305–309.PubMedGoogle Scholar
  133. 133.
    Borg T, Modig J. Potential anti-thrombotic effects of local anaesthetics due to their inhibition of platelet aggregation. Acta Anaesthesiol Scand 1985;29:739–742.PubMedGoogle Scholar
  134. 134.
    de Leon-Casasola OA, Parker BM, et al. Epidural analgesia versus intravenous patient-controlled analgesia: differences in the postoperative course of cancer patients. Reg Anesth 1994;19:307–315.PubMedGoogle Scholar
  135. 135.
    Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 1998;86:598–612.PubMedCrossRefGoogle Scholar
  136. 136.
    Smith J, Kelly K. Pathophysiology of postoperative ileus. Arch Surg 1977;112:203–209.PubMedGoogle Scholar
  137. 137.
    Holte K, Kehlet H. Postoperative ileus—a preventable event? Br J Surg 2000;87:1480–1493.PubMedCrossRefGoogle Scholar
  138. 138.
    Kehlet H, Holte K. Review of postoperative ileus. Am J Surg 2001;182:3S–10S.PubMedCrossRefGoogle Scholar
  139. 139.
    Lui SS, Carpenter RL, Mackey DC, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 1995;83:757–765.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Bernadette Veering
    • 1
  1. 1.Department of AnesthesiologyLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations