Cardiovascular Effects of Ketamine in Humans with Cervical or Lumbar Epidural Blockade

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Abstract
To examine the effect of sympathectomy induced by epidural blockade on the cardiovascular effects of ketamine anesthesia, the changes in arterial blood pressure (AP) and heart rate (HR) following i.v. administration of ketamine were compared in patients who had cervical epidural anesthesia (n = 18), lumbar epidural anesthesia (n = 16), or light anesthesia alone (n = 16). Ketamine, 2 mg/kg, i.v., produced statistically significant increases in both AP and HR in all patients studied. The percent increases in systolic AP in the cervical group were statistically less than those in the lumbar epidural group and control groups (P < 0.05), which did not significantly differ from each other. The changes in HR following ketamine in the cervical group were significantly less than those in the other 2 groups (at 3-10 min following ketamine; P < 0.05). The cardiovascular stimulatory effects of ketamine are evidently suppressed partially by a high level of epidural anesthesia but not by a low level of epidural blockade. Since patients with cervical epidural anesthesia had an analgesic level extending between C4 and Th8, the above attenuative effects of epidural blockade may be considered to be attributable to cardiac sympathectomy induced by a high level of epidural anesthesia.

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