Impact of High Thoracic Epidural Anesthesia on Hemodynamics during On-Bypass Coronary Artery Bypass Grafting
Objective. The use of high thoracic epidural blockade anesthesia in cardiac operations may be limited due to its adverse hemodynamic effects. Aim. To evaluate the impact of high thoracic epidural blockade anesthesia on hemodynamic during on-bypass coronary artery bypass grafting (CABG). Methods. In 85 patients underwent on-bypass CABG hemodynamic parameters were measured including cardiac index (CI), stroke index (SI), ejection fraction (EF) and systemic vascular resistance index (SVRI). Results. Moderate hypodynamic circulation developed after induction: CI — 2.27 ± 0.69 L • min–1• m–2 and SVRI — 2618 (2064; 3032) din • sec • cm–5 • m–2. Nevertheless systolic function was improving as evidenced by the EF growth. After cardiopulmonary bypass hemodynamic pattern changed over to moderate hyperdynamic one: CI increased to 3.72 ± 0.96 L • min–1 • m–2 due to rise heart rate and improving global systolic cardiac function though SVRI decreased. Conclusion. During on-bypass high thoracic epidural blockade anesthesia majority of hemodynamic parameters kept within reference values. After induction global systolic function grew, indicating an improvement of the heart conditions under the influence of high thoracic epidural blockade anesthesia.
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