The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery

Gamal Z El-Morsy, Alaa El-Deeb, Gamal Z El-Morsy, Alaa El-Deeb

Abstract

Background: Thoracic epidural anesthesia (TEA) improves analgesia and outcomes after a cardiac surgery. As aging is a risk factor for postoperative pulmonary complications, TEA is of particular importance in elderly patients undergoing coronary artery bypass graft (CABG).

Methods: Fifty patients aged 65-75 years; ASA II and III scheduled for elective CABG were included in the study. Patients were randomized to receive either general anesthesia (GA) group alone or GA combined with TEA group. Heart rate (HR), mean arterial pressure (MAP), and central venous pressure were recorded. Total dose of fentanyl μg/kg, aortic cross clamping, cardiopulmonary bypass (CPB) time, time to first awaking and extubation, arterial blood gases, visual analog scale (VAS) score in intensive care unit were reported. Postoperative pulmonary function tests were done.

Results: TEA showed a significant HR and lower MAP compared with the GA group. The total dose of intraoperative fentanyl and nitroglycerine were significantly lower in the TEA. Patients in TEA group have statistically significantly higher PaO(2), lower PaCO(2), increase in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV(1))

Conclusions: TEA reduced severity of postoperative pulmonary function and restoration was faster in TEA group in elderly patients undergoing CABG. Also, it resulted in earlier extubation and awakening, better analgesia, lower VAS.

Keywords: Coronary artery bypass graft; elderly; thoracic epidural anesthesia.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Perioperative heart rate changes (beat/min)
Figure 2
Figure 2
Perioperative mean blood pressure changes
Figure 3
Figure 3
Perioperative central venous pressure changes

References

    1. Jensen L, Yang L. Risk factors for postoperative pulmonary complications in coronary artery bypass graft surgery patients. Eur J Cardiovasc Nurs. 2007;6:241–6.
    1. Mehta Y, Vats M, Sharma M, Arora R, Trehan N. Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patients with chronic obstructive pulmonary disease. Ann Card Anaesth. 2010;13:224–30.
    1. Crescenzi G, Landoni G, Monaco F, Bignami E, De Luca M, Frau G, et al. Epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2009;23:807–12.
    1. Sharma M, Mehta Y, Sawhney R, Vats M, Trehan N. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m2 for off pump coronary artery bypass surgery. Ann Card Anaesth. 2010;13:28–33.
    1. Hachenberg T, Tenling A, Nyström SO, Tyden H, Hedenstierna G. Ventilation-perfusion inequality in patients undergoing cardiac surgery. Anesthesiology. 1994;80:509–19.
    1. Guinard JP, Mavrocordatos P, Chiolero R, Carpenter RL. A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology. 1992;77:1108–15.
    1. Chaney MA. Intrathecal and epidural anesthesia and analgesia for cardiac surgery. Anesth Analg. 2006;102:45–64.
    1. Stenseth R, Bjella L, Berg EM, Christensen O, Levang OW, Gisvold SE. Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery. Eur J Cardiothorac Surg. 1996;10:859–65.
    1. Fillinger MP, Yeager MP, Dodds TM, Fillinger MF, Whalen PK, Glass DD. Epidural anesthesia and analgesia: Effects on recovery from cardiac surgery. J Cardiothorac Vasc Anesth. 2002;16:15–20.
    1. Salvi L, Sisillo E, Brambillasca C, Juliano G, Salis S, Marino MR. High thoracic epidural anesthesia for off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2004;18:256–62.
    1. Kessler P, Aybek T, Neidhart G, Dogan S, Lischke V, Bremerich DH, et al. Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: General anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone. J Cardiothorac Vasc Anesth. 2005;19:32–9.
    1. Scott NB, Turfrey DJ, Ray DA, Nzewi O, Sutcliffe NP, Lal AB, et al. A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting. Anesth Analg. 2001;93:528–35.
    1. Royse C, Royse A, Soeding P, Blake D, Pang J. Prospective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery. Ann Thorac Surg. 2003;75:93–100.
    1. Liem TH, Hasenbos MA, Booij LH, Gielen MJ. Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome. J Cardiothorac Vasc Anesth. 1992;6:156–61.
    1. Quasha AL, Loeber N, Feeley TW, Ullyot DJ, Roizen MF. Postoperative respiratory care: A controlled trial of early and late extubation following coronary-artery bypass grafting. Anesthesiology. 1980;52:135–41.
    1. Priestley MC, Cope L, Halliwell R, Gibson P, Chard RB, Skinner M, et al. Thoracic epidural anesthesia for cardiac surgery: The effects on tracheal intubation time and length of hospital stay. Anesth Analg. 2002;94:275–82.
    1. Shayevitz JR, Merkel S, O’Kelly SW, Reynolds PI, Gutstein HB. Lumbar epidural morphine infusions for children undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 1996;10:217–24.
    1. Mehta Y, Arora D, Sharma KK, Mishra Y, Wasir H, Trehan N. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery. Ann Card Anaesth. 2008;11:91–6.
    1. Gruber EM, Tschernko EM, Kritzinger M, Deviatko E, Wisser W, Zurakowski D, et al. The effects of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 2001;92:1015–9.
    1. Goodarzi M. Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery. Paediatr Anaesth. 1999;9:419–22.
    1. Sabbe MB, Yaksh TL. Pharmacology of spinal opioids. J Pain Symptom Manage. 1990;5:191–203.
    1. Gulle E, Skärvinge C, Runberg K, Robinson Y, Olerud C. Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients. Patient Saf Surg. 2011;5:1–10.
    1. Karacalar S, Bilen CY, Sarihasan B, Sarikaya S. Spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy. J Endourol. 2009;23:1591–7.
    1. Bloch MB, Dyer RA, Heijke SA, James MF. Tramadol infusion for postthoracotomy pain relief: A placebo-controlled comparison with epidural morphine. Anesth Analg. 2002;94:523–8.

Source: PubMed

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