Korean J Anesthesiol.  1999 Jan;36(1):52-61. 10.4097/kjae.1999.36.1.52.

Hemodynamic Evaluation of Thoracic Epidural Analgesia Combined with General Anesthesia in Coronary Artery Bypass Surgery

• Lee BH
• Chung MY
• Chea JS
• Kim CJ
• Park KH

• KMID: 1935124
• DOI: http://doi.org/10.4097/kjae.1999.36.1.52

Abstract

BACKGROUND: High dose fentanyl anesthesia has been recommended for circulatory stability during coronary artery bypass grafting (CABG), but hypertension and tachycardia in response to noxious stimulation have been noted. The purpose of this study was to evaluate the hemodynamic effects of extensive thoracic epidural analgesia (TEA) combined with general anesthesia (GA).
METHODS
The hemodynamic effects in CABG were evaluated in 30 patients. They were randomized into two groups ; the GA group receiving high dose fentanyl (50-70 mcg/kg), the TEA group receiving 10 ml bupivacaine 5 mg ml 1 followed by 5 ml every two hours epidurally GA (N2O-O2). The hemodynamic parameters were evaluated before induction of anesthesia, 20 minutes after induction of anesthesia, after sternotomy, and 30 minutes after end of cardiopulmonary bypass.
RESULTS
Heart rate and mean arterial pressure were significantly lower after sternotomy in the TEA group compared to the GA group. Significant increase in cardiac index and decrease in central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure were found after induction of anesthesia and sternotomy in the TEA group compared to the GA group. Especially, the pulmonary vascular resistance was significantly lower during all the period in the TEA group compared to the GA group. No differences were observed in stroke volume index, systemic vascular resistance, left ventricular stroke work index between two groups.
CONCLUSIONS
The present study suggests a more effective blockade of the stress response during CABG with TEA than with GA. So, we consider that TEA could be used as an adjunctive anesthetic method during CABG.

Keyword

Anesthetic techniques, thoracic epidural; Heart, coronary artery disease, hemodynamics; Surgery, coronary artery bypass graft; Heart, coronary artery disease, hemodynamics; Surgery, coronary artery bypass graft

MeSH Terms

Analgesia, Epidural*
Anesthesia
Anesthesia, General*
Arterial Pressure
Bupivacaine
Cardiopulmonary Bypass
Central Venous Pressure
Coronary Artery Bypass*
Coronary Vessels*
Fentanyl
Heart Rate
Hemodynamics*
Humans
Hypertension
Pulmonary Wedge Pressure
Sternotomy
Stroke
Stroke Volume
Tachycardia
Tea
Vascular Resistance
Bupivacaine
Fentanyl
Tea