Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery

Stenseth, Roar; Bjella, Lise; Em, Berg; Christensen, O; Ow, Levang; Se, Gisvold

doi:10.1016/s1010-7940(96)80311-3

Cited by 96 publications

(45 citation statements)

References 15 publications

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“…4,5,7,14 However, patients with epidurals in these studies, were extubated three to five hours postoperatively, while tracheal extubation took place within minutes of the conclusion of the operation in our study, the majority of the time while patients were in the operating room. The details of our ultra-fast track program have been described elsewhere.…”

Section: Discussionmentioning

confidence: 56%

“…However, there have been conflicting reports regarding the effects of TEA on postoperative pulmonary function and atelectasis. [3][4][5][6] A recent meta-analysis by Liu et al 12 with a combined total of 1,178 patients, found that TEA decreased the incidence of pulmonary complications. in the present study, TEA was associated with a significant improvement in pulmonary function during the first two postoperative days, using FEV 1 as a surrogate for pulmonary function.…”

Section: Discussionmentioning

confidence: 99%

“…2 The effects on pulmonary function have also been studied; however, conflicting results have been reported. [3][4][5][6][7] Scott et al 3 reported superior pre-extubation vital capacity in coronary artery bypass graft (CABg) surgery patients with thoracic epidurals. Conversely, Sternest et al 4 infused 0.5% bupivacaine postoperatively, and did not find a difference in postoperative spirometry in CABg surgery patients.…”

mentioning

confidence: 99%

“…[3][4][5][6][7] Scott et al 3 reported superior pre-extubation vital capacity in coronary artery bypass graft (CABg) surgery patients with thoracic epidurals. Conversely, Sternest et al 4 infused 0.5% bupivacaine postoperatively, and did not find a difference in postoperative spirometry in CABg surgery patients. Priestley et al 5 administered ropivacaine 1% with fentanyl, postoperatively, and documented no difference in postoperative spirometry.…”

mentioning

confidence: 99%

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Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Tenenbein

Debrouwere

Maguire

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Pulmonary dysfunction commonly occurs following coronary artery bypass graft (CABG) surgery, increasing morbidity and mortality. We hypothesized that thoracic epidural anesthesia (TEA) would improve pulmonary function and would decrease complications in patients undergoing CABG surgery.Methods: This prospective, randomized, controlled trial was conducted with Ethics Board approval. Fifty patients, undergoing CABG surgery, were randomized to the epidural group or to the patient-controlled analgesia morphine group. Patients in the epidural group received a high, thoracic epidural, preoperatively. Intraoperatively, 0.75% ropivacaine was infused, followed postoperatively, by 0.2% ropivacaine for 48 hr. Outcome measurements included: visual analogue pain scores; spirometry; atelectasis scores on chest radiographs; and the incidence of atrial fibrillation. Results:Twenty-five patients were enrolled in each group. Patients in the epidural group had significantly less pain on the operative day, and for the subsequent two days. Compared to baseline, the forced expiratory volume in one second was significantly higher in the epidural group, on the first and second postoperative days (43.7 ± 12.2% vs 36.4 ± 12.0%, p < 0.002, and 43.3 ± 12.5% vs 38.4 ± 11.0%, p <0.05). There was significantly more atelectasis in the control group, four hours postoperatively (p < 0.04); however, on the third, postoperative day, the groups were similar with regards to this outcome. The incidence of atrial fibrillation was similar in both groups, and there were no complications related to the epidural. (43,7 ± 12,2 % vs 36,4 ± 12,0 %, p < 0,002, et 43,3 ± 12,5 % vs 38,4 ± 11,0 %, p < 0,05 Conclusions

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Tenenbein

Debrouwere

Maguire

et al. 2008

Can J Anesth/J Can Anesth

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“…Post-operative pain may cause hypo-ventilation and insufficient cough, leading to retention of airway secretions and aggravation of the impaired lung function. 6 General Anaesthesia is the most commonly used anaesthetic technique and is considered the gold standard for CABG, performed either on-pump or off-pump. Within the last few years, however, high thoracic epidural analgesia (TEA) as an adjunct to General Anaesthesia has become more prevalent and has been shown to have potentially benefited in patients with coronary artery disease.…”

Section: Evaluation Of Pulmonary Function After Offpump Coronary Artementioning

confidence: 99%

Evaluation of Pulmonary Function after Off- Pump Coronary Artery Bypass Graft Surgery with Thoracic Epidural Analgesia.

et al. 2013

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Introduction:Coronary artery disease is the most common form of heart disease and the single most important cause of premature death in the developed world. 1 Surgical management of Ischaemic heart disease (IHD) is coronary artery bypass graft surgery (CABG), which can be performed either under cardiopulmonary bypass (CPB) or by using offpump technique. Impairment of pulmonary function after CABG is one of the most common complications in the early post-operative period. 2 Sternotomy, pleurotomy with opening of the pleural space, harvesting of internal mammary artery and pain may lead to deterioration of postoperative pulmonary function. In addition, the incidence of concurrent chronic lung disease is higher in the age group of patients who require revascularization of the myocardium. Combined these two factors indicate a need for documentation of pulmonary function pre-and postoperatively. .3Coronary revascularization procedure is done usually through median sternotomy incision and for this; impairment of pulmonary function is one of the most significant post-operative complication of CABG. 4 For revascularization, emphasis is given over internal mammary artery (IMA) graft. The mediastinum and thoracic cavity are traumatized more with IMA than with reverse saphenous

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Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery

Pöpping¹,

Elia²,

Marret³

et al. 2008

Arch Surg

483

218

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To review the impact of epidural vs systemic analgesia on postoperative pulmonary complications.Data Sources: Search of databases (1966( to March 2006 and bibliographies.Study Selection: Inclusion criteria were randomized comparison of epidural vs systemic analgesia lasting 24 hours or longer postoperatively and reporting of pulmonary complications, lung function, or gas exchange. Fiftyeight trials (5904 patients) were included.Data Extraction: Articles were reviewed and data extracted. Data were combined using fixed-effect and random-effects models.Data Synthesis: The odds of pneumonia were decreased with epidural analgesia (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.43-0.68), independent of site of surgery or catheter insertion, duration of analgesia, or regimen. The effect was weaker in trials that used patient-controlled analgesia in controls (OR, 0.64; 95% CI, 0.49-0.83) compared with trials that did not (OR, 0.30; 95% CI, 0.18-0.49) and in larger studies (OR, 0.62; 95% CI, 0.47-0.81) compared with smaller studies (OR, 0.37; 95% CI, 0.23-0.58). From 1971-2006, the incidence of pneumonia with epidural analgesia remained about 8% but decreased from 34% to 12% with systemic analgesia (P Ͻ.001); consequently, the relative benefit of epidural analgesia decreased also. Epidural analgesia reduced the need for prolonged ventilation or reintubation, improved lung function and blood oxygenation, and increased the risk of hypotension, urinary retention, and pruritus. Technical failures occurred in 7%. Conclusion:Epidural analgesia protects against pneumonia following abdominal or thoracic surgery, although this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.

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Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery

Abstract: Thoracic epidural analgesia yields a slight, but significant, improvement in pulmonary function, most likely due to a more profound postoperative analgesia.

Cited by 96 publications

References 15 publications

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Evaluation of Pulmonary Function after Off- Pump Coronary Artery Bypass Graft Surgery with Thoracic Epidural Analgesia.

Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery

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