A Syndrome Due to Transient or Changing Heart-block
1962; BMJ; Volume: 2; Issue: 5320 Linguagem: Inglês
10.1136/bmj.2.5320.1638
ISSN0959-8138
Autores Tópico(s)Cardiac Arrhythmias and Treatments
ResumoEPIDURAL ANALGESIA BRrIISHevent 40 minutes or even longer after epidural injection of what might have seemed a not too excessiv_e dose in a patient of normal biological age. SummaryInjection of local anaesthetic solutions into the spinal extradural space results in a segmental type of analgesia.In normal subjects the number of analgesic dermatomos can be predicted with an accuracy of 15 to 30(,%b in terms of age and the concentration and volume of local anaes- thetic used.The amount of local anaesthetic required to block a given area declines steadily after the second decade, in a manner reminiscent of some other curves relating biological phenomena to age.Fifty-three patients with occlusive vascular disease reacted abnormally to epidural analgesia.They behaved as if they were 25 to 50 years older than their chrono- logical age, or as if the injected solution had been twice the concentration actually used.In these patients segmental analgesia spread one and a half to three times further than in normal subjects of the same age.This tendency to increased spread can be hazardous if the anaesthetist is not aware of the necessity for reduced dosage in arteriosclerotic patients.The timen taken for epidural analgesia to reach its farthest limits varies quite widely in normal subjects, and does not appear to be dependent on age.This time interval is prolonged in arteriosclerotic patients.The significance of these findings is discussed in relation to the effects of ageing processes, and to the site of action of epidural analgesia.I am grateful to my col!eagues in the Department of
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