Comparison of influence of high thoracic epidural anesthesia and central analgesia on hemodynamic during on-bypass coronary artery bypass grafting

Authors

  • V. A. Sobokar
  • S. N. Gritsenko
  • M. S. Potapenko

DOI:

https://doi.org/10.14739/2310-1210.2015.3.44487

Keywords:

Epidural Anesthesia, Analgesia, Hemodynamics

Abstract

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.

How to Cite

1.
Sobokar VA, Gritsenko SN, Potapenko MS. Comparison of influence of high thoracic epidural anesthesia and central analgesia on hemodynamic during on-bypass coronary artery bypass grafting. Zaporozhye Medical Journal [Internet]. 2015Jun.15 [cited 2024Dec.2];17(3). Available from: http://zmj.zsmu.edu.ua/article/view/44487

Issue

Section

Original research