ABSTRACT
Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά), interleukin-6 and leucocyte count. Design: A prospective randomised non blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin: – 6, TNF ά, cortisol, Troponin – I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result: Study group showed decreased Interlukin – 6 at day 2, TNF ά at day 2 and 5,troponin I at day 5, and decreased total hospital stay ( p < 0.05). Conclusion: Thoracic epidural anesthesia decreases stress and inflammatory response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.
Subject(s)
Aged , Aged, 80 and over , /administration & dosage , Anesthesia, Epidural/methods , Anesthesia, General/methods , Anesthetics/pharmacology , Biomarkers , Coronary Artery Bypass/methods , Coronary Artery Bypass, Off-Pump/methods , Humans , Male , Postoperative Complications , Postoperative Period , RiskSubject(s)
Coronary Artery Bypass, Off-Pump , Female , Humans , Leeching/adverse effects , Middle AgedSubject(s)
Aedes , Animals , Coronary Artery Bypass , Coronary Artery Bypass, Off-Pump , Dengue/complications , Dengue/transmission , Dengue Virus , Edema/etiology , Edema/physiopathology , Fluid Therapy , Humans , India , Male , Middle Aged , Platelet Count , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Thrombocytopenia/etiology , Thrombocytopenia/therapySubject(s)
Blood Transfusion/adverse effects , Cardiac Surgical Procedures/adverse effects , Cardiopulmonary Bypass/adverse effects , Data Interpretation, Statistical , Health Resources/statistics & numerical data , Humans , Morbidity , Postoperative Care/statistics & numerical data , Postoperative Complications/epidemiologyABSTRACT
Following renal transplantation, patients for coronary artery bypass grafting are subjected to high morbidity and mortality during the perioperative period because of the risk of major infections, renal impairment or rejection, and myocardial infarction. We describe the perioperative management of one such high-risk patient.