Document Detail


High Thoracic Epidural Analgesia in Cardiac Surgery: Part 1-High Thoracic Epidural Analgesia Improves Cardiac Performance in Cardiac Surgery Patients.
MedLine Citation:
PMID:  22770758     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate the perioperative cardioprotective effect of high thoracic epidural analgesia (HTEA), primarily expressed as an effect on cardiac performance and hemodynamics in patients undergoing cardiac surgery. DESIGN: A randomized, prospective study. PARTICIPANTS: Sixty low-to-moderate risk patients between the ages of 65 and 80 years scheduled for elective coronary artery bypass graft surgery with or without aortic valve replacement. SETTING: A university hospital. INTERVENTION: Patients randomized to receive HTEA as a supplement to general anesthesia. MEASUREMENTS AND MAIN RESULTS: Perioperative hemodynamic measurements, perioperative fluid balance, and postoperative release of cardiac enzymes were collected. The end-diastolic volume index (EDVI), the stroke volume index (overall 38 v 32 mL), the cardiac index (overall 2.35 v. 2.18 L/minute/m(2)), the central venous pressure, and central venous oxygenation were higher in the HTEA group. The mean arterial blood pressure was marginally lower in the HTEA group, whereas no difference was noted in the heart rate or peripheral saturation between the groups. No differences were found in the postoperative levels of troponin T and CK-MB between groups. NT-proBNP changed over time (p < 0.001) and was lower in the HTEA group (p = 0.013), with maximal values of 291 ± 265 versus 326 ± 274. CONCLUSIONS: The findings of a higher stroke volume index and central venous oxygenation without an increase in heart rate or mean arterial pressure suggest that HTEA improves cardiac performance in elderly cardiac surgery patients.
Authors:
Carl-Johan Jakobsen; Rajesh Bhavsar; Dorthe Viemose Nielsen; Pia Katarina Ryhammer; Erik Sloth; Jacob Greisen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-5
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  -     ISSN:  1532-8422     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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