Comparative Study of Haemodynamic Status and Arrhythmia between Combined Epidural with General Anaesthesia and General Anaesthesia alone in Off-pump Coronary Artery Bypass (OPCAB) Surgery (original) (raw)
Related papers
Cardiovascular Journal
Background: In the postoperative period inadequate analgesia may increase morbidity by causing adverse haemodynamic, metabolic, immunologic and haemostatic attentions and prolong mechanical ventilation with more ICU stay. This study has been undertaken to compare postoperative outcome in off-pump coronary artery bypass surgery (OPCAB) between high thoracic epidural anaesthesia (HTEA) as an adjunct to general anaesthesia (GA) vs. GA alone. Methods : This prospective, randomized case control comparative study was carried out in sixty patients without having left main coronary artery disease, left ventricular ejection fraction <30% or contraindication of regional anaesthesia scheduled for OPCAB. They were divided into two groups, thirty in each group. Group A received GA alone and group B received high thoracic epidural anaesthesia with GA. Requirement of postoperative analgesics, pain score, sedation score, and post-operative complications were evaluated. Results: Rescue analgesics...
Interactive cardiovascular and thoracic surgery, 2013
Off-pump coronary artery bypass (OPCAB) surgery is a technically more demanding strategy of myocardial revascularization compared with the standard on-pump technique. Thoracic epidural anaesthesia, by reducing sympathetic stress, may ameliorate the haemodynamic changes occurring during OPCAB surgery. The aim of this randomized controlled trial was to evaluate the impact of thoracic epidural anaesthesia on intraoperative haemodynamics in patients undergoing OPCAB surgery. Two hundred and twenty-six patients were randomized to either general anaesthesia plus epidural (GAE) (n = 109) or general anaesthesia (GA) only (n = 117). Mean arterial blood pressure (MAP), heart rate (HR) and central venous pressure (CVP) were measured before sternotomy and subsequently after positioning the heart for each distal anastomosis. Both groups were well balanced with respect to baseline characteristics and received a standardized anaesthesia. The MAP decreased in both groups with no significant differe...
Anesthesiology, 2011
Background The aim of this two-center, open, randomized, controlled trial was to evaluate the impact of thoracic epidural anesthesia on early clinical outcomes in patients undergoing off-pump coronary artery bypass surgery. Methods Two hundred and twenty-six patients were randomized to either general anesthesia plus epidural (GAE) (n = 109) or general anesthesia only (GA) (n = 117). The primary outcome was length of postoperative hospital stay. Secondary outcomes were: arrhythmia, inotropic support, intubation time, perioperative myocardial infarction, neurologic events, intensive care stay, pain scores, and analgesia requirement. Results Baseline characteristics were similar in the two groups. One patient died in the GAE group. Median postoperative stay was significantly reduced in the GAE, compared with the GA, group (5 days, interquartile range [5-6] vs. 6 days, interquartile range [5-7], hazard ratio = 1.39, 95% CI [1.06-1.82]; P = 0.017). The incidence of arrhythmias and the me...
Anaesthesia, 1997
We have performed a retrospective analysis of the peri-operative course of 218 consecutive patients who underwent routine coronary artery bypass graft surgery in this institution. All patients received a standardised general anaesthetic using target-controlled infusions of alfentanil and propofol. One hundred patients also received thoracic epidural anaesthesia with bupivacaine and clonidine, started before surgery and continued for 5 days after surgery. The remaining 118 patients received target-controlled infusion of alfentanil for analgesia for the first 24 h after surgery, followed by intravenous patient-controlled morphine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory, neurological, renal, gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p 0.02). There was also a trend towards a reduced incidence of respiratory complications in the thoracic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patients being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurological problems resulting from the use of thoracic epidural analgesia.
Annals of Cardiac Anaesthesia, 2011
To evaluate the effect of thoracic epidural anesthesia (TEA) on tissue oxygen delivery and utilization in patients undergoing cardiac surgery. This prospective observational study was conducted in a tertiary referral heart hospital. A total of 25 patients undergoing elective off-pump coronary artery bypass surgery were enrolled in this study. All patients received thoracic epidural catheter in the most prominent inter-vertebral space between C7 and T3 on the day before operation. On the day of surgery, an arterial catheter and Swan Ganz catheter (capable of measuring cardiac index) was inserted. After administering full dose of local anesthetic in the epidural space, serial hemodynamic and oxygen transport parameters were measured for 30 minute prior to administration of general anesthesia, with which the study was culminated. A significant decrease in oxygen delivery index with insignificant changes in oxygen extraction and consumption indices was observed. We conclude that TEA does not affect tissue oxygenation despite a decrease in arterial pressures and cardiac output.
2016
Coronary artery bypass graft (CABG) surgery is the most common type of heart surgery in the United States. The main benefit of CABG surgery is a significant decrease in myocardial infarction rate, while the most common complications of CABG are myocardial damage and atrial fibrillation. The incorporation of epidural anesthesia occurred in order to decrease sympathetic nervous system response during CABG but has not been extensively studied. A systematic review was conducted to compare the cardiovascular outcomes of the addition of thoracic epidural anesthesia to the anesthetic plan versus general anesthesia as a solo technique during coronary artery bypass grafting surgery. The PubMed database was searched to identify randomized controlled trials in adult patients undergoing CABG with implementation of thoracic epidural anesthesia versus general anesthesia only. Seven studies involving 668 participants met the criteria. A previously published meta- analysis of randomized controlled ...
Anesthesia for off-pump coronary artery bypass surgery
Annals of Cardiac Anaesthesia, 2013
Off-pump coronary artery bypass presents special challenges for the anesthesiologist and surgeon, who must work closely together to provide optimal care. Displacement and immobilization of the heart for exposure of the coronary arteries, as well as occlusion of these vessels, can result in periods of significant hemodynamic instability. Appropriate preparation, guided therapy, and technical maneuvers can lessen such adverse hemodynamic impact. It is important for anesthesiologists to be aware of the special problems associated with this surgery, as well as the different therapies and maneuvers that can be useful in providing the best possible care. As surgeons develop greater expertise and better devices for the management of these patients, the number of coronary revascularizations without CPB is likely to increase.
The Open Anesthesia Journal
Aim: To investigate the effect of high thoracic epidural analgesia combined with general anesthesia on pain management and postoperative outcomes in patients undergoing off-pump Coronary Artery Bypass Grafting (CABG). Materials and Methods: Patients were divided into two groups; Group 1 received general anesthesia and high thoracic epidural anesthesia whereas Group 2 received general anesthesia alone during off-pump coronary artery bypass grafting. Epidural catheters were placed at least 6 hours before transfer to the operating room. An epidural analgesic solution of 0.25% bupivacaine and 10 µg/ml fentanyl was started as continuous infusion at 5 ml/hour and maintained for at least 12 hours after completion of surgery. A 10-cm visual analog scale was used to measure pain at 4th, 6th, 9th and 12th postoperative hours. Results: Mean time to extubation was similar between two groups (2.45±0.88 vs. 2.59±1.31 for Groups 1 and 2, respectively, p=0.90). In all measurements, mean Visual Anal...
Can J Anaesth, 2002
Purpose: This study was designed to examine the efficacy of low-dose intrathecal morphine (ITM) on extubation times and pain control after cardiac surgery. Methods: 43 patients undergoing elective cardiac surgery were enrolled in this prospective, randomized, double-blind placebo controlled trial. Patients were given a pre-induction dose of ITM (6 µg•kg-1 per ideal body weight in 5 mL normal saline, group ITM) or 5 mL of intrathecal normal saline (group ITS). Anesthesia was induced with thiopental (3 mg•kg-1), sufentanil, midazolam and rocuronium. The total allowable doses of sufentanil and midazolam for the entire case were limited to 0.5 µg•kg-1 and 0.045 mg•kg-1 respectively. Anesthesia was maintained with isoflurane before and during cardiopulmonary bypass (CPB), and with propofol after CPB. In the postanesthesia care unit, patients received nurse-administered morphine followed by patient-controlled analgesia morphine. Serial visual analogue scale pain scores, morphine use, mini-mental state examinations and pulmonary function tests were measured for 48 hr. Patient satisfaction questionnaires were completed at the time of discharge. Results: Mean times to extubation from the application of dressings were short and did not differ between groups (ITM = 41.4 ± 33.0 min, ITS = 39.2 ± 37.1 min). During the first 24 hr postoperatively, the ITM group had improved pain control and a lower iv morphine requirement than the control group, both at rest and during deep breathing. Both forced expiratory volume in one second and forced vital capacity were improved in the ITM group. There were no differences in spinal-related side effects or in the overall complication rates. Patient satisfaction was high in both groups. Conclusion: Low-dose ITM for cardiac surgery did not delay early extubation, but it improved postoperative analgesia and pulmonary function. Objectif : Vérifier l'efficacité d'une faible dose de morphine intrathécale (MIT) sur le temps d'extubation précoce et le contrôle de la douleur après une opération en cardiochirurgie. Méthode : L'étude prospective, randomisée et à double insu contre placebo a été menée auprès de 43 patients de cardiochirurgie élective. Les patients ont reçu une dose de MIT avant l'induction (6 µg•kg-1 par poids corporel idéal dans 5 mL de solution salée, groupe MIT) ou 5 mL de solution salée intrathécale (groupe SIT). L'anesthésie a été induite avec du thiopental (3 mg•kg-1), du sufentanil, du midazolam et du rocuronium. Les doses totales permises de sufentanil et de midazolam pour toute l'opération ont été respectivement limitées à 0,5 µg•kg-1 et à 0,045 mg•kg-1. L'anesthésie a été maintenue avec de l'isoflurane avant et pendant la circulation extracorporelle (CEC), et avec du propofol après la CEC. À la salle de réveil, les patients ont reçu de la morphine administrée par une infirmière, puis par injection auto-contrôlée. Les séries de scores de douleur de l'échelle visuelle analogique, la consommation de morphine, les mini-examens de l'état mental et l'exploration respiratoire fonctionnelle ont été mesurés pendant 48 h. Des questionnaires sur la satisfaction des patients ont été remplis au moment du départ.