Epidural anesthesia in urology

Indications for epidural anesthesia have been analyzed on the basis of 1483 cases of its application. They include transvesical adenomectomy, transurethral electroresection of prostatic adenoma, distant renal and ureteral lithotripsy. It is emphasized that epidural anesthesia is an advantage in older and senile individuals with associated respiratory and circulatory diseases. Epidural anesthesia provides some protection against complications like a transurethral resection syndrome and coagulation disorders. The practical use of epidural anesthesia during urologic operations is safe when its level does not extend above the 9-10th dermatome. A range of measures is offered to prevent complications of epidural anesthesia by stabilizing the hemodynamics and improving blood rheology, coagulation, and humoral status.     

Epidural abscess and regional anesthesia

An epidural abscess is a rare lesion whose consequences can cause high morbi-mortality, particularly in obstetrics, where it occurs in young, healthy patients. With increased use of regional anesthesia, the incidence of epidural abscess will increase. We therefore review the risk factors, most common etiology and clinical signs, which may be non-specific but are nevertheless suggestive. We also review available diagnostic methods. It may be difficult to distinguish epidural abscess from other causes of medullar compression, but prompt diagnosis is essential so that emergency surgical repair can proceed and neurological recovery will be as early and complete as possible. Appropriate antibiotic therapy should be aggressive. Basic aseptic measures are critical for preventing infection through epidural needles, as the presence of infection at the moment of puncture facilitates greater susceptibility to epidural abscess.     

Epidural anesthesia and spinal anesthesia in the elderly

Epidural anesthesia and spinal anesthesia are very popular anesthetic techniques used for surgery in elderly patients. Aging i s associated withanatomical changes and a loss of functional reserve in all organ systems. These neuraxial blocks affect physiological function to some extent. However, previous studies have demonstrated only a slight effect of age on the anesthetic levels as well as the reduction in functions with these blocks. In elderly patients, both anesthetic techniques have been shown to decrease intraoperative blood loss, perioperative cardiac ischemic events, post-operative hypoxic episodes and arterial and venous thrombosis, and so forth.     

Epidural anesthesia and pulmonary function

The epidural administration of local anesthetics can provide anesthesia without the need for respiratory support or mechanical ventilation. Nevertheless, because of the additional effects of epidural anesthesia on motor function and sympathetic innervation, epidural anesthesia does affect lung function. These effects, i.e., a reduction in vital capacity (VC) and forced expiratory volume in 1 s (FEV_1.0), are negligible under lumbar and low thoracic epidural anesthesia. Going higher up the vertebral column, these effects can increase up to 20% or 30% of baseline. However, compared with postoperative lung function following abdominal or thoracic surgery without epidural anesthesia, these effects are so small that the beneficial effects still lead to an improvement in postoperative lung function. These results can be explained by an improvement in pain therapy and diaphragmatic function, and by early extubation. In chronic obstructive pulmonary disease (COPD) patients, the use of thoracic epidural anesthesia has raised concerns about respiratory insufficiency due to motor blockade, and the risk of bronchial constriction due to sympathetic blockade. However, even in patients with severe asthma, thoracic epidural anesthesia leads to a decrease of about 10% in VC and FEV_1.0 and no increase in bronchial reactivity. Overall, epidural administration of local anesthetics not only provides excellent anesthesia and analgesia but also improves postoperative outcome and reduces postoperative pulmonary complications compared with anesthesia and analgesia without epidural anesthesia.