Document Detail


Superior haemodynamic stability during off-pump coronary surgery with thoracic epidural anaesthesia: results from a prospective randomized controlled trial.
MedLine Citation:
PMID:  23357523     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Off-pump coronary artery bypass (OPCAB) surgery is a technically more demanding strategy of myocardial revascularization compared with the standard on-pump technique. Thoracic epidural anaesthesia, by reducing sympathetic stress, may ameliorate the haemodynamic changes occurring during OPCAB surgery. The aim of this randomized controlled trial was to evaluate the impact of thoracic epidural anaesthesia on intraoperative haemodynamics in patients undergoing OPCAB surgery.
METHODS: Two hundred and twenty-six patients were randomized to either general anaesthesia plus epidural (GAE) (n = 109) or general anaesthesia (GA) only (n = 117). Mean arterial blood pressure (MAP), heart rate (HR) and central venous pressure (CVP) were measured before sternotomy and subsequently after positioning the heart for each distal anastomosis.
RESULTS: Both groups were well balanced with respect to baseline characteristics and received a standardized anaesthesia. The MAP decreased in both groups with no significant difference (mean difference (GAE minus GA) -1.11, 95% CI -3.06 to 0.84, P = 0.26). The HR increased in both groups after sternotomy but was significantly less in the GAE group (mean difference (GAE minus GA) -4.29, 95% CI -7.10 to -1.48, P = 0.003). The CVP also increased in both groups after sternotomy, but the difference between the groups varied over time (P = 0.05). A difference was observed at the third anastomosis when the heart was in position for the revascularization of the circumflex artery (mean difference (GAE minus GA) +2.09, 95% CI 0.21-3.96, P = 0.03), but not at other time points. The incidence of new arrhythmias was also significantly lower in the GAE compared with the GA group (OR = 0.41, 95% CI 0.22-0.78, P = 0.01).
CONCLUSION: Thoracic epidural with general anaesthesia minimizes the intraoperative haemodynamic changes that occur during heart positioning and stabilization for distal coronary anastomosis in OPCAB surgery.
Authors:
Chanaka Rajakaruna; Chris Rogers; Katie Pike; Hazaim Alwair; Alan Cohen; Sally Tomkins; Gianni D Angelini; Massimo Caputo
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-01-27
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  16     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-22     Completed Date:  2013-11-04     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  602-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia, Epidural* / adverse effects
Anesthesia, General
Blood Pressure
Coronary Artery Bypass, Off-Pump* / adverse effects
England
Female
Heart Rate
Hemodynamics*
Humans
Male
Middle Aged
Monitoring, Intraoperative / methods
Prospective Studies
Sternotomy
Treatment Outcome
Grant Support
ID/Acronym/Agency:
2003-2006//British Heart Foundation
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