Comparison of influence of high thoracic epidural anesthesia and central analgesia on hemodynamic during on-bypass coronary artery bypass grafting
DOI:
https://doi.org/10.14739/2310-1210.2015.3.44487Keywords:
Epidural Anesthesia, Analgesia, HemodynamicsAbstract
Objective. Despite some advantages, the use of high thoracic epidural anesthesia (HTEA) during cardiac operations may be discouraged by fear of adverse hemodynamic effects. Aim. To compare the hemodynamic effects of HTEA and central analgesia (CA) during on-bypass CABG.
Methods. 132 patients were assigned into two groups – study group (n = 85), where the surgery was carried out under HTEA and control group (n = 47) - where the surgery was carried out under CA. Data of the intraoperative monitoring and trans-oesophageal cardiac ultrasound - cardiac index (CI), stroke index (SI), ejection fraction (EF) and index of systemic vascular resistance (ISVR) were obtained.
Results. After induction and sternotomy patients in the study group had higher EF - 57(53, 65)% vs 54 ± 7% (p = 0,013) and 55 ± 8 vs 52 ± 9%, (p = 0,031). After sternotomy CI and SI in the study group were also higher, respectively 2,42 (2,0;3,1) vs 2,23±0,63 l · min-1 · m-2, (p = 0,041) and 43 (34;46) vs 37±10 ml · m-2 (p = 0.014).
Conclusion. We concluded that HTEA has advantages over CA by its influence on hemodynamics.
References
Mitter, N., Grogan, K., Nyhan, D., & Berkowitz, D. E. (2011) Pharmacology of Anesthetic Drugs. Opioids in Cardiac Anesthesia. In Kaplan's Cardiac Anesthesia. The Echo Era. J.A. Kaplan (Ed.), (P. 223–224). Philadelphia: Saunders Elsevier.
Chamchad, D, Horrow, J. C., Nachamchik, L., Sutter, F. P., Samuels, L. E., Trace, C. L., et al. (2010) The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J Cardiothorac Vasc Anesth, 24, 780–784. doi: 10.1053/j.jvca.2010.04.002.
Haanschoten, M. C., van Straten, A. H., ter Woorst, J. F., Stepaniak, P. S., van der Meer, A.D., van Zundert, A. A., & Soliman Hamad, M. A. (2012) Fast-track practice in cardiac surgery: results and predictors of outcome. Interact Cardiovasc Thorac Surg., 15(6), 989–94. doi: 10.1093/icvts/ivs393.
Greisen, J., Nielsen, D., Sloth, E., & Jakobsen, C. (2013) High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients. Acta Anaesthesiol Scand., 57(2), 171–7. doi: 10.1111/j.1399-6576.2012.02731.x.
Gurses, E., Berk, D., Sungurtekin, H., Mete, A., & Serin, S. (2013) Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery. Med Sci Monit., 19, 222–229. doi: 10.12659/MSM.883861.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
