Effects of Perioperative Central Neuraxial Analgesia on Outcome after Coronary Artery Bypass Surgery

Liu, Spencer S.; Block, Brian M.; Wu, Christopher L.

doi:10.1097/00000542-200407000-00024

Cited by 321 publications

(159 citation statements)

References 46 publications

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“…However, there have been conflicting reports regarding the effects of TEA on postoperative pulmonary function and atelectasis. [3][4][5][6] A recent meta-analysis by Liu et al 12 with a combined total of 1,178 patients, found that TEA decreased the incidence of pulmonary complications. in the present study, TEA was associated with a significant improvement in pulmonary function during the first two postoperative days, using FEV 1 as a surrogate for pulmonary function.…”

Section: Discussionmentioning

confidence: 99%

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Tenenbein

Debrouwere

Maguire

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Pulmonary dysfunction commonly occurs following coronary artery bypass graft (CABG) surgery, increasing morbidity and mortality. We hypothesized that thoracic epidural anesthesia (TEA) would improve pulmonary function and would decrease complications in patients undergoing CABG surgery.Methods: This prospective, randomized, controlled trial was conducted with Ethics Board approval. Fifty patients, undergoing CABG surgery, were randomized to the epidural group or to the patient-controlled analgesia morphine group. Patients in the epidural group received a high, thoracic epidural, preoperatively. Intraoperatively, 0.75% ropivacaine was infused, followed postoperatively, by 0.2% ropivacaine for 48 hr. Outcome measurements included: visual analogue pain scores; spirometry; atelectasis scores on chest radiographs; and the incidence of atrial fibrillation. Results:Twenty-five patients were enrolled in each group. Patients in the epidural group had significantly less pain on the operative day, and for the subsequent two days. Compared to baseline, the forced expiratory volume in one second was significantly higher in the epidural group, on the first and second postoperative days (43.7 ± 12.2% vs 36.4 ± 12.0%, p < 0.002, and 43.3 ± 12.5% vs 38.4 ± 11.0%, p <0.05). There was significantly more atelectasis in the control group, four hours postoperatively (p < 0.04); however, on the third, postoperative day, the groups were similar with regards to this outcome. The incidence of atrial fibrillation was similar in both groups, and there were no complications related to the epidural. (43,7 ± 12,2 % vs 36,4 ± 12,0 %, p < 0,002, et 43,3 ± 12,5 % vs 38,4 ± 11,0 %, p < 0,05 Conclusions

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Section: Discussionmentioning

confidence: 99%

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Tenenbein

Debrouwere

Maguire

et al. 2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…12 On the other hand, a recent meta-analysis including 1178 patients found that although TEA is associated with shorter time until tracheal intubation and decreased pulmonary complications and cardiac arrhythmias, no effect on mortality or rates of myocardial infarction could be found. 30 However, most of the studies included in this meta-analysis were small (Յ50 treated patients), and because the pooled mortality rate of the study was low, the authors concluded that more larger-scale randomized controlled trials are required to fully assess the potential benefits of TEA for the reduction of myocardial infarction and mortality after CABG.…”

Section: Discussionmentioning

confidence: 99%

Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

et al. 2005

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Background-In patients with ischemic heart disease, high thoracic epidural analgesia (TEA) has been proposed to improve abnormalities of coronary function by inhibiting cardiac sympathetic tone. We evaluated the effect of TEA on myocardial blood flow in patients with ischemic heart disease. Methods and Results-Twenty male patients with multivessel ischemic heart disease were studied. An epidural catheter was inserted between the second and third thoracic vertebral interspace (Th2 to Th3). Analgesia was induced by epidural injection of bupivacaine 0.5%, and a sensory block from the sixth cervical (C6 to C7) to Th10 (Th8 to Th11) vertebral interspace was achieved. Myocardial blood flow was measured with dynamic 13 N-ammonia PET with and without TEA at rest, during pharmacological vasodilation with dipyridamole, and during sympathetic stimulation with the cold pressor test. Myocardial blood flow during dipyridamole increased similarly, regardless of TEA, in all regions except in myocardium subtended by collateral arteries in which blood flow increased more with than without TEA (PϽ0.05). Without TEA, myocardial blood flow during the cold pressor test remained unchanged compared with myocardial blood flow at rest. In contrast, with TEA, myocardial blood flow increased in all vascular territories. Coronary vascular resistance increased during the cold pressor test without TEA, whereas with TEA, coronary resistance decreased in myocardium subtended by nonstenotic and stenotic coronary vessels and remained unchanged in myocardium subtended by occluded vessels. Conclusions-In patients with multivessel ischemic heart disease, TEA partly normalizes the myocardial blood flow response to sympathetic stimulation.

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“…1,2 A recently-published meta-analysis provides some perspective. 8 These authors, via Medline and other databases, searched for randomized controlled trials in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Fifteen trials enrolling 1,178 patients were included for thoracic epidural analysis and 17 trials enrolling 668 patients were included for intrathecal analysis.…”

mentioning

confidence: 99%

“…1,2 Une méta-analyse, publiée récemment, fournit une certaine perspective. 8 Les auteurs ont utilisé, entre autres, la base Medline pour chercher des essais randomisés et contrôlés auprès de patients devant subir un pontage aortocoronarien avec circulation extracorporelle. Quinze essais comprenant 1 178 patients ont été inclus pour analyse de l'anesthésie péridurale thoracique et 17 essais auprès de 668 patients pour analyse de l'anesthésie intrathécale.…”

unclassified

Cardiochirurgie et techniques intrathécale/péridurale : sommes-nous à la croisée des chemins ?

Chaney

2005

Can J Anesth/J Can Anesth

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Effects of Perioperative Central Neuraxial Analgesia on Outcome after Coronary Artery Bypass Surgery

Cited by 321 publications

References 46 publications

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

Cardiochirurgie et techniques intrathécale/péridurale : sommes-nous à la croisée des chemins ?

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