Comparative Study of Haemodynamic Status and Arrhythmia between Combined Epidural with General Anaesthesia and General Anaesthesia alone in Off-pump Coronary Artery Bypass (OPCAB) Surgery

Abstract

Objectives: To find out if combined general anaesthesia (GA) with high thoracic epidural anaesthesia (HTEA) was better in controlling haemodynamic condition and reducing incidences of arrhythmia during induction of GA and during positioning and handling of the heart itself by the surgeons. Materials and Method: Forty (40) patients of 40-65 yrs age were randomly selected and divided in two groups (group A, n= 20: combined HTEA and GA- study group, group B, n= 20: GA alone- control group). Group A received HTEA introduced through an indwelling epidural catheter at C7-T1 or T1-T2 interspace. Lignocaine (1%) 5 ml and Bupivacain (0.25%) 5ml with Fentanyl 10 mg was given through the catheter as bolus followed by Bupivacain (0.25%) 5ml with Fentanyl 10 mg was given at 2 hours interval. General anaesthesia was induced and maintained in a standardized manner for all patients of both the groups. The parameters monitored were Heart Rate (HR), Arterial Blood Pressure (ABP), and Electrocardiogram (ECG - arrhythmia and ST changes), Oxygen saturation (SpO2) and Central Venous Pressure (CVP) during the procedure Results: Induction of GA was smoother and with fewer blood pressure peaks in all patients of group A. They demonstrated a stable haemodynamic status throughout operation in general and during positioning of the heart and bypass grafting in particular. Incidences and severity of cardiac arrhythmias were also less during these periods. Conclusion: Combined HTEA-GA technique for OPCAB procedure is safe and affords to achieve stable haemodynamic status during induction of GA. It also allows reducing incidence of arrhythmias during cardiac position and grafting. Regarding the above qualities, group A appeared superior to group B. DOI: 10.3329/jbcps.v26i3.4193 J Bangladesh Coll Phys Surg 2008; 26: 116-120

Clinical outcome of the off-pump coronary artery bypass surgery- a comparison between combined high thoracic epidural anaesthesia with GA and GA alone

“…In this study it was observed that per-operative mean CVP changes at during anastomosis of distal end of the graft with PDA, LCX, D1/D2 and OM1/OM2/OM3 were significantly (p<0.05) higher in group A and others were almost consistent between two groups. On the other hand In this study it was found that per-operative arrhythmia ventricular tachycardia (VT) 10.0% in group A but none was found in group B which is similar with Kundu et al 18 study. Arrhythmia ventricular fibrillation (VF) was 3.3% in group A and none was found in group B, which closely resembles with Bakhtiary et al Study 21 .…”

“…The higher range of the different studies may be due to increased life expectancy in their country.In the current study the male patients was predominant, which is consistent with Kessler et al 1 , Salvi et al 20 and Scott et al 19 studies. In this study it was observed that per-operative mean heart rate changes at wound closure and during anastomosis of distal end of the graft with D1/D2 were not statistically significant (p>0.05), however rest of others times were significantly (p<0.05) less in group B, which is comparable with Kundu et al, Kessler et al, and Salvi et al Studies 18,1,20 . It was found in this current study that per-operative mean of mean arterial pressure (MAP) changes at intubation, skin incision, sternotomy, pericardiotomy were significantly (p<0.05) higher in group A but during anastomosis of distal end of the graft with RCA, PDA, LCX and D1/D2 were ignificantly (p<0.05) higher in group B and others were almost similar between two groups.…”

“…Study 21 , where they observed 27.3% and 6.1% in group A and group B respectively and Kundu et al 18 study observed 40.0% and 10.0%. Arrhythmia atrial fibrillation (AF) not occurred in both group in the present study, however Kundu et al 18 observed in this study 10.0% in group A. Bakhtiary et al 18 reported 27.3% in group A and 6.1% in group B, which differ with the present study, this may be due to left main disease was excluded and GA was given with TIVA in the presents study.…”

Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials

“…We shortlisted 51 RCTs (2112 TEA and 2220 GA) in the meta-analysis (Figure 1). 6,7,20,21,36–82 The pooled age (TEA: 62.8 years; 95% CI, 60.8–64.8 versus GA: 62.7 years; 95% CI, 60.6–64.7), body mass index (BMI; TEA: 27.7; 95% CI, 26.8–28.7 versus GA: 27.9; 95% CI, 26.8–29.0), and left ventricular ejection fraction (LVEF, TEA: 55.1%; 95% CI, 51.8–58.3 versus GA: 54.8%; 95% CI, 49.8–59.8) were similar between both groups. Forty-three studies were solely on coronary artery bypass grafts, while 8 studies included other cardiac surgeries such as valve replacements, including combined coronary artery bypass and valve replacement surgeries.…”

Cardiac Drugs Requirement during Off-Pump Coronary Artery Bypass (OPCAB) Surgery- A Comparison between Combined High Thoracic Epidural Anaesthesia (HTEA) with GA and GA Alone

“…Kundu et al 18 In this study it is observed that during coronary artery anastomosis in the difficult territories of the heart, anesthetist and surgeon felt more comfort during positioning of the heart and during anastomosis of the graft due to better cardiovascular stabilities in group B.…”