Regional analgesia and ultra-fast-track cardiac anesthesia

Cheng, Davy

doi:10.1007/bf03018574

Cited by 16 publications

(13 citation statements)

References 32 publications

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“…Thoracic epidural anesthesia has been associated with the most cardiac benefits by improving myocardial oxygen balance. Intrathecal narcotics have been shown to shorten the duration of mechanical ventilation and tracheal intubation by improving analgesia in fast-track cardiac surgery [11]. In fact, perioperative central neuraxial blockade may actually improve outcome after coronary artery bypass grafting (CABG).…”

Section: Cardiac Anesthesiamentioning

confidence: 99%

Spinal anesthesia

Mordecai

Brull

2005

Current Opinion in Anaesthesiology

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Innovations in technology, equipment, and needle design improved safety and decreased complication rates from spinal anesthesia. The increased popularity of ambulatory surgical procedures has resulted in more frequent use of spinal anesthesia. Intrathecal narcotic analgesia is used increasingly in fast-tracking cardiac surgical protocols. Modern anesthetic and analgesic techniques include resurgence of older agents (2-chloroprocaine) as well as new agents (levobupivacaine and ropivacaine) that are used in conjunction with adjuvant intrathecal medications (opioids, vasopressors, and alpha-2 adrenergic agonists). Surgical thromboprophylaxis and the increased use of anticoagulants in patients with cardiovascular disease have challenged anesthesiologists to update clinical guidelines to minimize the risk of hemorrhagic complications such as epidural hematoma. The risk/benefit ratio of spinal anesthesia should be individualized. The continued popularity of spinal anesthesia is due to the safety, effectiveness and efficiency of this technique.

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Section: Cardiac Anesthesiamentioning

confidence: 99%

Spinal anesthesia

Mordecai

Brull

2005

Current Opinion in Anaesthesiology

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“…[1,2] It helps to avoid postoperative complications, and has the potential to decrease Intensive Care Unit (ICU) and hospital stay. [3] Some studies have advocated the use of regional anesthesia [4][5][6] and short-acting anesthetic agents such as sevoflurane or desflurane, to achieve the earliest extubation time, including desflurane would be ideally suited for ultra-fast tracking anesthesia, as both allow rapid extubation even as they provide similar myocardial protection. However, some studies indicate the risk of catecholamine stimulation [13] with desflurane.…”

Section: Introductionmentioning

confidence: 99%

“…

immediate extubation after surgery (Ultra-fast track anesthesia [5,7] ). Immediate extubation is especially achievable when off-pump coronary artery bypass grafting (OPCABG) is used, [3,7] as it decreases operating time and avoids important pathophysiological changes usually induced by extracorporeal circulation.

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confidence: 99%

Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: A pilot study

et al. 2010

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“…Routine use of low-dose opioid regimens and shorter-acting anesthetic agents facilitate extubation 1 to 6 hours after arrival in the intensive care unit [3]. Early extubation, facilitated by effective postoperative pain control, has potential benefits such as cost containment and rapid recovery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

Saini¹,

Chauhan²,

Kiran³

et al. 2015

WJCS

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Objective: The objective of this study was to compare the efficacy of 0.5% ropivacaine and 0.25% bupivacaine for parasternal intercostal block for postoperative analgesia in children undergoing cardiac surgery. Design: A randomized, controlled, prospective, double blind study. Setting: A tertiary care teaching hospital. Participants: One Hundred children scheduled for cardiac surgery through a median sternotomy were divided into 3 groups of at least 33 children each, receiving either ropivacaine, bupivacaine or saline (control). Interventions: A bilateral parasternal block performed either with 0.5% ropivacaine or 0.25% bupiacaine or 0.9% saline with 5 doses of 0.5 mL on each side in the 2nd to 6th parasternal intercostal spaces 1 to 1.5 cm lateral to the sternal edge, before sternal wound closure. Measurements and Main Results: The time to extubation was significantly less in children administered the parasternal blocks with ropivacaine or bupivacaine compared to the saline (control) group. The pain scores were lower and comparable in the ropivacaine and bupivacaine groups compared to the saline group. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine (p < 0.001) and bupivacaine group. No side effects were observed in any of the children. Conclusions: Parasternal blocks either with ropivacaine or bupivacaine appear to be a simple, safe, and useful technique for supplementation of postoperative analgesia in children undergoing cardiac surgery with a median sternotomy.

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Regional analgesia and ultra-fast-track cardiac anesthesia

Cited by 16 publications

References 32 publications

Spinal anesthesia

Spinal anesthesia

Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: A pilot study

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

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