ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
High thoracic epidural anesthesia in coronary artery bypass graft surgery
Mukadder Demirok, Demet Aşkın, İlter Emin
Vehbi Koç Vakfı Amerikan Hastanesi Kardiyovasküler Cerrahi Anestezi Kliniği, İstanbul
Background: The effects of high thoracic epidural anesthesia (HTEA) in coronary artery bypass graft surgery (CABGS) on the extubation and recovery times in the intensive care unit (ICU), and on blood gases and incidence of arrhythmia were evaluated.

Methods: Two groups (study and control) of 50 patients, each candidates for CABGS, with similar preoperative risk factors, age, gender, and weight were included in the study. The patients had standard premedication, monitorization, anesthesia induction. After intubation, the epidural catheter was inserted at a side-position between thoracal 1-2 or thoracal 2-3 spinal levels to the group of patients designated for HTEA (study group). A bolus of 20 ml was administered from a priorly prepared solution of 0.1% Bupivacaine + 4 µg/ml Fentanyl. Thereafter, 0.1 ml/kg of the solution was infused throughout the operation and continued for 48 hours postoperatively. Patients in the control group were perfused with 0.1 mg/kg pethidin HCl off-pump and continued for 48 hours postoperatively. Pain assessment in both groups was performed by the 5-point pain scale or the Visual Analog Scale (VAS) and the dose was adjusted to keep the VAS pain level under 4. Extubation and ICU stay duration, atrial fibrillation incidence and blood gas alterations were compared between the twogroups.

Results: Compared to controls, extubation (p<0.001) and recovery times in ICU (p<0.005) were significantly shorter in the study group. The incidence of atrial fibrillation was lower in the study group, though the difference was not statistically significant. PO2 and SPO2 saturation levels did not change after extubation in study high thoracic epidural anesthesia group, but PO2 decreased substantially in the control group (p<0.001).

Conclusion: HTEA is a safe method for analgesia and anaesthesia in open heart surgery, when used by experienced physicians on selected patients. This method can be preferred especially for patients with lung problems and patients needing early mobilization.

Keywords : Anesthesia, epidural; cardiac surgical procedures; coronary disease
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