ABSTRACT
Background: In Bangladesh, although OPCAB surgery are done, the number of centers are limited and as a result, studies on this subject are also few. Consequently, there are no exclusive data regarding the best anaesthetic technique in the context of superior haemodynamic stability. This study has been undertaken with a view to find out whether a combined HTEA with GA (TIVA) is safe and more efficient in providing overall cardiovascular stability. The common challenges for the cardiac anaesthesiologist during off pump coronary artery surgery (OPCAB) to maintain optimal cardiovascular parameters such as heart rate, blood pressure, CVP and arrhythmias during the different stressful surgical events and multiple cardiac manipulations, providing adequate myocardial protection, are sometimes difficult. This study has been undertaken with a view to find out whether a combined HTEA with TIVA is safe and more efficient in providing overall cardiovascular stability. Method: Sixty patients aged between 40-70 years, without having any coagulopathy disorder , any emergency surgery or left main disease scheduled for CABG on beating heart were enrolled in prospective, randomized observational comparative study. Patients were divided in two groups. In group A patients received TIVA alone and in group B patients received high thoracic epidural anaesthesia with TIVA. The parameters including heart rate , SPO2 , CVP , arterial blood pressure , rate pressure product , arrhythmia in ECG, were recorded before induction, during induction , intubation and during different events of the surgery ( skin incision, sternotomy, pericardiotomy, coronary artery anastomosis with graft , sternum closure and wound closure) was recorded. Result: Significant per-operative mean heart rate changes were observed all the events except at wound closure and during anastomosis with D1/D2 and the mean difference of mean of mean arterial pressure at intubations, skin incision, sternotomy, pericardiotomy, during anastomosis of distal end of the graft with RCA, PDA, LCX and D1/D2 were observed statistically significant (p<0.05) . No incidence of different arrhythmia occurred in group B, premature ventricular complex (PVC) was statistically significant (p<0.05) between two groups. Conclusion: HTEA with TIVA appeared to be most comprehensive, allowing for revascularization of any coronary artery, providing good cardiovascular stability during OPCAB.
ABSTRACT
Background: In recent years, high thoracic anaesthesia (HTEA) combined with general anaesthesia has been extensively studied in patients undergoing coronary artery bypass graft surgery with or without cardiopulmonary bypass. Off-pump coronary artery bypass grafting was implemented to reduce trauma of surgical coronary revascularization by avoiding extracorporeal circulation. TEA in combination with GA further reduces intraoperative stress resulting in more rapid extubation and significantly better pain relief in patients undergoing off-pump coronary artery bypass grafting (OPCAB). In addition, common postoperative complications are also decreased. Methodology: 40 male patients aged between 40-65 years with CAD undergoing OPCAB surgery at NICVD from April 2006 to October 2008 were randomly divided in two groups. Group A received epidural analgesic drugs through an indwelling catheter introduced before induction of anesthesia while group B patients received standard general anesthesia (GA) alone. Group A patients received continuous epidural analgesia delivered through the indwelling catheter with a mixture of Lignocaine (2%) 20 ml + Bupivacaine (0.5%) 20 ml + Fentanyl 50 gm 1 ml + normal saline q.v. 50 ml at the rate of 1-2 ml/hour by a syringe pump for up to 72 hours. Group B patients received conventional intermittent narcotics (Morphine)/NSAIDS (Ketorolac/Diclofen) for up to 72 hours. Results: Haemodynamic parameters of all patients in both the groups were within acceptable range throughout operations. Incidence of cardiac dysrhythmias was less in patients of group A. Group A patients showed faster recovery and better analgesia compared to Group B patients. There was also decreased incidence of nausea, vomiting, arrhythmia, O2 desaturation, confusional states, renal failure and requirement of iontropic support in ICU in Group A patients. TEA for postoperative analgesia was safe and well accepted by the patients. There was no complication related to epidural anesthesia in any patient. Conclusion: TEA in general anesthesia provides faster recovery and effective analgesia. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated.