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.
Full Text:PDF (Українська)
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
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020