Impact of High Thoracic Epidural Anesthesia on the Hemodynamics During Coronary Artery Bypass Grafting
Background. The use of high thoracic epidural anesthesia (HTEA) in cardiac surgeries may be deterred by fear of its adverse hemodynamic effects. Objective: to evaluate the impact of HTEA on hemodynamics during coronary artery bypass grafting (CABG). Methods. In 85 patients during CABG we have evaluated cardiac index (CI), stroke volume index, ejection fraction (EF) and total peripheral vascular resistance index (TPVRI). Results. After induction, there was a hypodynamic type of circulation: CI — 2.27 ± 0.69 L•min–1•m–2, TPVRI — 2,618 (2,064; 3,032) din•s•cm–5•m–2, with improved systolic function, as evidenced by increased EF. After bypass, there was а hyperdynamic type of circulation: CI increased up to 3.72 ± 0.96 L•min–1•m–2, due to heart rate and systolic function of the heart, and TPVRI reduced. Conclusions. When carrying out HTEA during coronary artery bypass grafting, the majority of hemodynamic parameters were within reference values, and after induction the parameters of the global systolic myocardial function increased indicating an improvement of cardiac performance.
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