Impact of High Thoracic Epidural Anesthesia on Hemodynamics during On-Bypass Coronary Artery Bypass Grafting

V.A. Sobokar, S.M. Gritsenko


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.


high thoracic epidural blockade; hemodynamics; on-bypass; coronary artery bypass grafting


Haanschoten MC, van Straten AH, ter Woorst JF, Stepaniak PS, van der Meer AD, van Zundert AA, Soliman Hamad MA. Fast-track practice in cardiac surgery: results and predictors of outcome. Interact Cardiovasc Thorac Surg. 2012; 15(6):989-94. doi: 10.1093/icvts/ivs393

Chamchad D, Horrow JC, Nachamchik L, Sutter FP, Samuels LE, Trace CL, Ferdinand F, Goldman SM. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay.J Cardiothorac Vasc Anesth. 2010; 24:780-784. doi: 10.1053/j.jvca.2010.04.002

Greisen J1, Nielsen DV, Sloth E, Jakobsen CJ. High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients. Acta Anaesthesiol Scand. 2013; 57(2):171-7. doi: 10.1111/j.1399-6576.2012.02731.x.

Ercan Gurses, Derviş Berk, Hülya Sungurtekin, Asli Mete,and Simay Serin. Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery. Med Sci Monit. 2013; 19:222–229. doi: 10.12659/MSM.883861

Jakobsen CJ, Bhavsar R, Nielsen DV, Ryhammer PK, Sloth E, Greisen J. High Thoracic Epidural Analgesia in Cardiac Surgery: Part 1—High Thoracic Epidural Analgesia Improves Cardiac Performance in Cardiac Surgery Patients. Journal of Cardiothoracic and Vascular Anesthesia. 2012; 26:1039-1047. doi: 10.1053/j.jvca.2012.05.007.

Suryaprakash S, Chakravarthy M, Gautam M, Gandhi A, Jawali V, Patil T, Jayaprakash K, Pandey S, Muniraju G. Effect of thoracic epidural anasthesia on oxygen delivery and utilization in cardiac surgery patients scheduled to undergor off-pump coronary artery bypass surgery: A prospective study. Ann Card Anaesth. 2011; 14:192 — 196. doi: 10.4103/0971-9784.83997.

Copyright (c) 2016 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта