Anaesthesia for coronary artery bypass surgery supplemented with subarachnoid bupivacaine and morphine: a report of 18 cases

Kowalewski, Richard; MacAdams, Charles; Eagle, Chris; Archer, David P.; Bharadwaj, B

doi:10.1007/bf03020660

Cited by 39 publications

(5 citation statements)

References 34 publications

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“…Although it has been well-established that ITM provides improved analgesia after cardiac surgery, this effect has not been extensively demonstrated with low-dose ITM analgesia. 8,[18][19][20] In the present study, we have shown that low-dose ITM allows for early extubation, while also providing improved pain control. A standardized anesthetic technique minimized the postoperative confounding variables for extubation time and analgesia, and also ensured that the patients were awake and cooperative soon after surgery; the patients were able to accurately participate in postoperative measurements of pain, mini-mental state and respiratory function.…”

Section: Discussionsupporting

confidence: 54%

Cardiothoracic Anesthesia, Respiration and Airway

Eric

Lee

Amadeo

et al. 2005

Can J Anesth/J Can Anesth

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Section: Discussionsupporting

confidence: 54%

Cardiothoracic Anesthesia, Respiration and Airway

Eric

Lee

Amadeo

et al. 2005

Can J Anesth/J Can Anesth

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“…Several studies have reported the HSA technique in cardiac surgery. The first descriptive case series was published in 1994 by Kowalewski et al ,31 who used intrathecal hyperbaric bupivacaine (23–30 mg) and/or lidocaine (150 mg) plus morphine (0.5–1 mg) for cardiac surgery. They reported that there was a decreased response to sternotomy and minimal requirement of postoperative analgesic.…”

Section: Discussionmentioning

confidence: 99%

Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study

Hanada

Kurosawa

Randall

et al. 2019

Reg Anesth Pain Med

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Background and objectivesAlthough high spinal anesthesia (HSA) has been used in cardiac surgery, the technique has not yet been widely accepted. This retrospective study was designed to investigate the impact of HSA technique on fast-track strategy in cardiac surgery.MethodsElective cardiac surgery cases (n=1025) were divided into two groups: cases with HSA combined with general anesthesia (GA) (HSA group, n=188) and cases with GA only (GA group, n=837). In the HSA group, bupivacaine and morphine were intrathecally administered immediately before GA was induced. Outcomes included fast-track extubation (less than 6 hours), extubation in the operating room, fast-track discharge from the intensive care unit (ICU) (less than 48 hours) and hospital (less than 7 days).ResultsIn the HSA group, 60.1% were extubated in less than 6 hours after ICU admission, as compared with 39.9% in the GA group (p<0.001). In the HSA group, 33.0% were extubated in the operating room, as compared with 4.4% in the GA group (p<0.001). LOS in the ICU was less than 48 hours in 67.6% in the HSA group, as compared with 57.2% of those in the GA group (p=0.033). LOS in the hospital was less than 7 days in 63.3% in the HSA group, as compared with 53.5% in the GA group (p=0.084).ConclusionsHSA technique combined with GA in cardiac surgery increased the rate of fast-track extubation (less than 6 hours) when compared with GA only.

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“…13 Although neuraxial anesthesia with intrathecal morphine has been studied in cardiac surgery, there is a dearth of literature regarding the hemodynamic effects of intrathecal morphine in combination with local anesthetics in cardiac surgery patients. [9][10][11][12][13]16,17 Vasoplegia after cardiac surgery is characterized by significant hypotension, high or normal cardiac index, low systemic vascular resistance, and increased requirements for fluids and vasopressors during or after CPB. With an incidence of 5-25%, it is difficult to treat and is associated with increased morbidity and mortality.…”

Section: Re ´Sumementioning

confidence: 99%

“…Invasive pressure monitoring of cardiac surgical patients and the timely use of bolus or continuous infusion of vasoactive agents like phenylephrine, norepinephrine, or epinephrine as per the hemodynamic requirements of underlying cardiac lesions enable successful use of such a technique. [8][9][10][11][12]16 The primary objective of this study was to compare the incidence of vasoplegia in two groups of patients, with one group receiving intrathecal local anesthetic and the other group receiving intrathecal morphine added to the local anesthetic. Secondary objectives included the time to extubation, postoperative rescue analgesic requirement, spirometry performance, and occurrence of any adverse event associated with intrathecal morphine (e.g., pruritus, nausea/vomiting, respiratory depression, and neuro-deficit) in the two groups.…”

Section: Re ´Sumementioning

confidence: 99%

Postoperative hemodynamics after high spinal block with or without intrathecal morphine in cardiac surgical patients: a randomized-controlled trial

Bhat

Arya

Mandal

et al. 2021

Can J Anesth/J Can Anesth

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Purpose There is some evidence for the use of intrathecal morphine as a means to provide prolonged analgesia in selective cardiac surgical patients; however, the hemodynamic effects of intrathecal morphine are not well defined. This study was designed to study the effect of intrathecal morphine on hemodynamic parameters in cardiac surgery patients. Methods In a prospective, double-blind study, 100 adult cardiac surgical patients were randomized to receive either intrathecal 40 mg of 0.5% hyperbaric bupivacaine alone (intrathecal bupivacaine [ITB] group, n = 50) or intrathecal 250 lg of morphine added to 40 mg of 0.5% bupivacaine (intrathecal bupivacaine and morphine [ITBM] group, n = 50). Hemodynamic data, pain scores, rescue analgesic use, spirometry, and vasopressor use were recorded every four hours after surgery for 48 hr. The primary outcome was the incidence of vasoplegia in each group, which was defined as a cardiac index [ 2.2 LÁmin -1 Ám -2 with the requirement of vasopressors to maintain the mean arterial pressure [ 60 mmHg with the hemodynamic episode lasting[four hours. Results Eighty-seven patients were analyzed (ITB group, n = 42, and ITBM group, n =45). The incidence of vasoplegia was higher in the ITBM group than in the ITB group [14 (31%) vs 5 (12%), respectively; relative risk, 2.6; 95% confidence interval [CI], 1.0 to 6.6; P = 0.04]. The mean (standard deviation [SD]) duration of vasoplegia was significantly longer in the ITBM group than in the ITB group [8.9 (3.0) hr vs 4.3 (0.4) hr, respectively; difference in means, 4.6; 95% CI, 3.7 to 5.5; P \ 0.001]. Conclusion Intrathecal morphine added to bupivacaine for high spinal anesthesia increases the incidence and duration of vasoplegia in cardiac surgery patients. Trial registration www.clinicaltrials.gov (NCT02825056); registered 19 June 2016.

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Anaesthesia for coronary artery bypass surgery supplemented with subarachnoid bupivacaine and morphine: a report of 18 cases

Cited by 39 publications

References 34 publications

Cardiothoracic Anesthesia, Respiration and Airway

Cardiothoracic Anesthesia, Respiration and Airway

Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study

Postoperative hemodynamics after high spinal block with or without intrathecal morphine in cardiac surgical patients: a randomized-controlled trial

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