Effects of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass surgery

Stenseth, Roar; Berg, Einar M.; Bjella, Lise; Christensen, O; Levang, Olaf W.; Gisvold, Sven Erik

doi:10.1016/s1053-0770(05)80131-4

Cited by 36 publications

(12 citation statements)

References 22 publications

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“…We conclude that thoracic epidural anaesthesia/analgesia is safe in cardiac surgery and can be performed on the day of surgery. Previous work by Stenseth et al (25, 26) in the 1990s involved the insertion of the epidural catheter on the day before surgery. Logistically, this can be problematic and leaves the patient with an indwelling catheter for an extra 24 h without gaining physiological benefit from it.…”

Section: Discussionmentioning

confidence: 99%

The risk of vertebral canal complications in 2837 cardiac surgery patients with thoracic epidurals*

Jack

Scott

2006

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

The risk of vertebral canal complications in 2837 cardiac surgery patients with thoracic epidurals*

Jack

Scott

2006

Acta Anaesthesiol Scand

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“…administration of sufentanil at moderate or higher doses was unable to protect the myocardium adequately from autonomic sympathetic response (10). Thoracic epidural analgesia (TEA) attenuates the surgically mediated sympathetic stress response to sternotomy, thereby preventing the increase in myocardial oxygen demand in the prebypass period without jeopardizing myocardial perfusion (7). The time to extubation was shorter and the incidence of postoperative pulmonary complications lower in the epidural group.…”

Section: Discussionmentioning

confidence: 99%

“…In adults during coronary artery bypass graft surgery, epidural anaesthesia attenuates the surgically mediated sympathetic stress response to sternotomy, reducing the incidence of postoperative dysrhythmias and adverse myocardial events. Respiratory complications are also decreased as are the need for postoperative mechanical ventilation and intensive care unit (ICU) stay (4–7). To date, there are few studies assessing the benefit of an epidural anaesthesia during paediatric cardiac surgery (8,9).…”

Section: Introductionmentioning

confidence: 99%

Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome

Bichel

Rouge

Schlegel

et al. 2000

Pediatric Anesthesia

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The metabolic and neuroendocrine effects of caudal epidural analgesia were studied during paediatric cardiac surgery. Combined epidural and general anaesthesia (EPI group; n=12) was compared with deep opioid anaesthesia (DOA group; n=12). During anaesthesia and surgery, haemodynamic stability was similar in the two groups. There was no significant difference between groups concerning the metabolic response to surgery but circulating catecholamines were significantly lower in the EPI group during and after surgery. Perioperative release of IL-6 was higher in the EPI group possibly reflecting a longer aortic clamp time. Incidence of postoperative life-threatening dysrhythmias was very low in the two groups. No significant reduction of postoperative mechanical ventilation, intensive care unit or hospital stays was reported with epidural analgesia. The incidence of postoperative infections was higher than expected in the two groups because of the poor properative clinical status of most of the children included in the study.

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“…Für die TEA konnten benefizielle Effekte bei Patienten mit KHK gezeigt werden, da die hochthorakale Sympathikolyse mit einer Verbesserung der Koronarperfusion insbesondere in nichtstenosierten Kollateralkreisläufen einherging, zu einer Senkung der Herzfrequenz und einer verminderten endogenen Stressantwort führt. Darüber hinaus verbessert die TEA die hämodynamische Stabilität und die postoperative pulmonale Funktion nach Eingriffen zur operativen Koronarrevaskularisation [9,38,41,43,64,68,69,71].…”

Section: Thorakale Epiduralanästhesieunclassified

Koronare Bypasschirurgie am wachen Patienten

Byhahn

Meininger²,

Kessler³

2008

Anaesthesist

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Patients undergoing coronary artery bypass grafting increasingly show severe co-morbidities, which can negatively affect the outcome. Recent developments in cardiac surgery have therefore focused on minimizing the invasiveness of the procedure by revascularization on the beating heart without cardiopulmonary bypass, and by reducing surgical trauma using smaller surgical incisions. Progress in minimally invasive cardiac surgery has led to minimally invasive anesthesia, i.e. using high thoracic epidural anesthesia as the sole technique in the conscious patient (awake coronary artery bypass grafting, ACAB). Published data on ACAB procedures in smaller cohorts have demonstrated that the procedure is safe. Significant complications occurred in 7.1% of patients. A particular cause of concern during ACAB surgery is the development of spinal epidural hematoma the risk of which has been estimated to be as high as 1:1,000. A thorough risk-benefit analysis has therefore to be made. Currently, ACAB surgery remains limited to few specialized centers and highly selected patients.

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Effects of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass surgery

Cited by 36 publications

References 22 publications

The risk of vertebral canal complications in 2837 cardiac surgery patients with thoracic epidurals*

The risk of vertebral canal complications in 2837 cardiac surgery patients with thoracic epidurals*

Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome

Koronare Bypasschirurgie am wachen Patienten

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