Thoracic Epidural Anesthesia During Coronary Artery Bypass Surgery

Kirnö, K; Friberg, Peter; A, Grzegorczyk; Milocco, I; Se, Ricksten; Lundin, Staffan

doi:10.1097/00132586-199604000-00007

Cited by 37 publications

(2 citation statements)

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“…As specifically regards the coronary vascular bed, experimental data show a prompt net release of t‐PA following selective stimulation of sympathetic cardiac nerves 29 or sternotomy 16 . The role of sternotomy as an initiator of sympathetic activation is illustrated by the fast increase in cardiac norephinephrine spillover observed in patients undergoing coronary artery bypass grafting 33 . Whether β‐adrenergic activation, generally implicated in the regulation of t‐PA, 34 is involved also in such mechanisms in the coronary circulation is still unsettled.…”

Section: Discussionmentioning

confidence: 99%

Impaired myocardial t‐PA release in patients with coronary artery disease

Österlund

Jern²,

Jern³

et al. 2008

Acta Anaesthesiol Scand

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Aims: Myocardial ischemia remains a significant perioperative complication in coronary artery disease (CAD) patients. We hypothesized that noxious stimuli during major surgery are associated with an acute release of tissue-type plasminogen activator (t-PA) into the coronary circulation, and that this response is reduced by CAD. Methods and results: Two patient groups, with (n 5 14) and without (n 5 8) CAD, were studied during the initial phase of heart surgery. After retrograde great cardiac vein catheterizations during closed-chest conditions, coronary arterial-venous concentration gradients of t-PA and plasminogen activator inhibitor type-1 (PAI-1) were measured together with coronary blood flow measurements, allowing derivation of coronary net release rates. Pre-surgery atrial pacing, performed to evaluate the influence of increases in heart rate (140 beats/min) and coronary blood flow (180 ml/min), did not significantly alter coronary net release of t-PA or PAI-1 in either patient group. Sternotomy induced a prominent increase in coronary net release of both total and active t-PA in the non-CAD group. This response was considerably reduced in the CAD group. Conclusions: This study provides the first analysis of coronary t-PA release during major surgery and demonstrates a deficient local endothelial t-PA release in patients with CAD. This suggests a reduced local fibrinolytic capacity in CAD patients, which may explain the increased risk for coronary thrombosis in this patient group.

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Section: Discussionmentioning

confidence: 99%

Impaired myocardial t‐PA release in patients with coronary artery disease

Österlund

Jern²,

Jern³

et al. 2008

Acta Anaesthesiol Scand

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show abstract

“…Because of these beneficial cardiac effects of TEA in CAD patients, it has been used as an adjunct to general anaesthesia in patients undergoing coronary artery bypass graft (CABG) surgery. Studies have shown that TEA in CABG surgery attenuates the surgical stress response, improves haemodynamic stability and decreases the incidence of perioperative myocardial ischaemia 8–10 . However, a meta‐analysis enrolling more than thousand patients could not demonstrate that TEA improved the rates of mortality or myocardial infarction in CABG surgery 11 .…”

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confidence: 99%