RESUMO
To evaluate the effect of thoracic epidural anesthesia (TEA) on tissue oxygen delivery and utilization in patients undergoing cardiac surgery. This prospective observational study was conducted in a tertiary referral heart hospital. A total of 25 patients undergoing elective off-pump coronary artery bypass surgery were enrolled in this study. All patients received thoracic epidural catheter in the most prominent inter-vertebral space between C7 and T3 on the day before operation. On the day of surgery, an arterial catheter and Swan Ganz catheter (capable of measuring cardiac index) was inserted. After administering full dose of local anesthetic in the epidural space, serial hemodynamic and oxygen transport parameters were measured for 30 minute prior to administration of general anesthesia, with which the study was culminated. A significant decrease in oxygen delivery index with insignificant changes in oxygen extraction and consumption indices was observed. We conclude that TEA does not affect tissue oxygenation despite a decrease in arterial pressures and cardiac output.
Assuntos
Anestesia Epidural , Ponte de Artéria Coronária sem Circulação Extracorpórea , Oxigênio/metabolismo , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Estudos ProspectivosAssuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Átrios do Coração , Cardiopatias/etiologia , Trombose/etiologia , Angina Pectoris/cirurgia , Ponte Cardiopulmonar , Doença Crônica , Ecocardiografia , Seguimentos , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação/métodos , Trombose/diagnóstico por imagem , Trombose/cirurgiaAssuntos
Anestesia Epidural/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Endarterectomia das Carótidas/métodos , Idoso , Anestesia Epidural/efeitos adversos , Anestesia Geral , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Sedação Consciente/métodos , Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Complicações do Diabetes , Feminino , Humanos , Intubação Intratraqueal , Masculino , Monitorização Intraoperatória/métodos , Tórax , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to evaluate the feasibility of thoracic epidural anesthesia as an alternative technique to general anesthesia in patients undergoing cardiac surgery under cardiopulmonary bypass. DESIGN: A prospective study. SETTING: Tertiary referral heart hospital. PARTICIPANTS: Eleven patients underwent cardiac surgical procedures requiring cardiopulmonary bypass under thoracic epidural anesthesia from February to April 2004. INTERVENTIONS: An epidural catheter was inserted at C7 to T2 intervertebral space on the day before the operation. Subsequently, cardiac surgery was performed using cardiopulmonary bypass. MEASUREMENTS AND RESULTS: The midsternotomy approach was used in all the patients. Anticoagulation was achieved with 300 units/kg of heparin. Under normothermic cardiopulmonary bypass, 6 patients underwent closure of atrial septal defect, 3 underwent valve replacements, and 2 underwent coronary artery bypass surgery combined with valve replacements. Soon after establishing cardiopulmonary bypass, all but 1 patient developed apnea, which was reversed after termination of cardiopulmonary bypass. The mean cardiopulmonary bypass time was 102 +/- 28 minutes, the aortic cross-clamp time was 58 +/- 28 minutes, and the total duration of surgery was 229 +/- 64 minutes. There was no mortality or morbidity in this series. CONCLUSION: Cardiac surgical procedures requiring cardiopulmonary bypass may be performed under thoracic epidural anesthesia, without endotracheal general anesthesia.
Assuntos
Anestesia Epidural/métodos , Anestesia Geral , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Sedação Consciente/métodos , Intubação Intratraqueal , Adulto , Idoso , Gasometria/métodos , Estudos de Viabilidade , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Estudos Prospectivos , Fatores de TempoRESUMO
PURPOSE: An audit of our first 151 cases of conscious off pump coronary artery bypass (COPCAB) surgery with epidural anesthesia as sole anesthetic. METHODS: Patients underwent conscious off pump coronary artery bypass (OPCAB) surgery using high thoracic epidural anesthesia. The epidural catheter was inserted on the day before the surgery. RESULTS: There were 118 male and 33 female patients. The incision was via midsternotomy except in 3 patients. Single graft was performed in 25 patients, double in 61, triple in 46, quadruple in 19. Twenty-nine patients developed pneumothorax. Three patients required conversion to general anesthesia. In one patient cardiopulmonary bypass (CPB) was instituted. There was no mortality in the group. CONCLUSION: Our experience shows that conscious OPCAB surgery can be performed safely in selected patients.
