Thoracic Epidural Anesthesia for Cardiac Surgery: The Effects on Tracheal Intubation Time and Length of Hospital Stay

Priestley, Mark; Cope, Louise; Halliwell, Richard; Gibson, Peter R.; Chard, Richard B.; Skinner, Michael H.; Klineberg, Peter L.

doi:10.1097/00000539-200202000-00009

Cited by 66 publications

(53 citation statements)

References 17 publications

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“…However, the groups were similar with respect to this outcome, by the third postoperative day. These results differ from those of Priestley et al 5 who were unable to show a difference, on chest radiographs, between the groups of patients with and without epidurals. it is plausible that the atelectasis scores were initially lower in the epidural group, because these patients had significantly less pain, and were, therefore, more compliant with deep breathing and coughing exercises.…”

Section: Discussioncontrasting

confidence: 99%

“…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%

“…2 The effects on pulmonary function have also been studied; however, conflicting results have been reported. [3][4][5][6][7] Scott et al 3 reported superior pre-extubation vital capacity in coronary artery bypass graft (CABg) surgery patients with thoracic epidurals. Conversely, Sternest et al 4 infused 0.5% bupivacaine postoperatively, and did not find a difference in postoperative spirometry in CABg surgery patients.…”

mentioning

confidence: 99%

“…Conversely, Sternest et al 4 infused 0.5% bupivacaine postoperatively, and did not find a difference in postoperative spirometry in CABg surgery patients. Priestley et al 5 administered ropivacaine 1% with fentanyl, postoperatively, and documented no difference in postoperative spirometry. one of the reasons for this lack of benefit may be explained by Tenling's 7 study, published in 2000, which showed that preoperative administration of epidural bupivacaine 0.5% caused a 15% decrease in vital capacity and a reduction in the rib cage contribution to tidal volume.…”

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confidence: 99%

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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: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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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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“…Thoracic epidural analgesia (TEA) is advantageous as adjunctive anesthesia and analgesia to fast-track patients after cardiac surgery [1][2][3] with superior pain management, [4][5][6][7][8][9] reduced opioid requirements, improved pulmonary function, 10,11 and myocardial protection. 12,13 Maintenance of body temperature is an important factor in achieving immediate extubation after OPCAB as shown by a recent retrospective study of ten patients, who were extubated in the operating theatre after OPCAB.…”

Section: Résultats : On a Pu Extuber 95 Patients Pendant Les 25 Premimentioning

confidence: 99%

Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epiduralbased anesthesia

Hemmerling

Prieto

Choinière

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the feasibility of immediate extubation after off-pump coronary artery bypass grafting (OPCAB) using opioid based analgesia or high thoracic epidural analgesia (TEA) and compare postoperative analgesia with continuous TEA vs patient-controlled analgesia (PCA).M Me et th ho od ds s: : One hundred consecutive patients undergoing OPCAB were included in this prospective audit. After induction of anesthesia using fentanyl 2 to 5 µg·kg -1 , propofol 1 to 2 mg·kg -1 and endotracheal intubation facilitated by rocuronium, anesthesia was maintained using sevoflurane titrated according to bispectral index monitoring. Perioperative analgesia was provided by TEA (n = 63) at the T3/T4 interspace or T4/T5 interspace using bupivacaine 0.125% 8 to 14 mL·hr -1 and repetitive boluses of bupivacaine 0.25% during surgery. In patients who were fully anticoagulated or refused TEA, perioperative analgesia was achieved by iv fentanyl boluses (up to 15 µg·kg -1 ) and remifentanil 0.1 to 0.2 µg·kg -1 ·min -1 , followed by morphine PCA after surgery (n = 37). Maintenance of body temperature was achieved by a heated operating room and forced-air warming blankets.R Re es su ul lt ts s: : Ninety-five patients were extubated within 25 min after surgery (PCA, n = 33; TEA, n = 62). Five patients were not extubated immediately because their core temperature was lower than 35°C. One patient was re-intubated because of agitation (TEA group); one was re-intubated because of severe pain and morphine-induced respiratory depression (PCA group). Pain scores were low after surgery, with pain scores in the TEA group being significantly lower immediately, at six hours, 24 hr and 48 hr after surgery (P < 0.05).C Co on nc cl lu us si io on n: : Immediate extubation is possible after OPCAB using either opioid-based analgesia or TEA. TEA provides significantly lower pain scores after surgery in comparison to morphine PCA. Objectif : Vérifier la faisabilité de l'extubation immédiatement après un pontage aortocoronarien à coeur battant (PACCB) en utilisant une analgésie avec opioïdes ou une analgésie péridurale thoracique (APT), et comparer l'analgésie postopératoire avec APT continue ou analgésie auto-contrôlée (AAC). Méthode : Cent patients consécutifs devant subir un PACCB ont été inclus dans un audit prospectif. Après l'induction de l'anesthésie avec

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Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery

Pöpping¹,

Elia²,

Marret³

et al. 2008

Arch Surg

476

218

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To review the impact of epidural vs systemic analgesia on postoperative pulmonary complications.Data Sources: Search of databases (1966( to March 2006 and bibliographies.Study Selection: Inclusion criteria were randomized comparison of epidural vs systemic analgesia lasting 24 hours or longer postoperatively and reporting of pulmonary complications, lung function, or gas exchange. Fiftyeight trials (5904 patients) were included.Data Extraction: Articles were reviewed and data extracted. Data were combined using fixed-effect and random-effects models.Data Synthesis: The odds of pneumonia were decreased with epidural analgesia (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.43-0.68), independent of site of surgery or catheter insertion, duration of analgesia, or regimen. The effect was weaker in trials that used patient-controlled analgesia in controls (OR, 0.64; 95% CI, 0.49-0.83) compared with trials that did not (OR, 0.30; 95% CI, 0.18-0.49) and in larger studies (OR, 0.62; 95% CI, 0.47-0.81) compared with smaller studies (OR, 0.37; 95% CI, 0.23-0.58). From 1971-2006, the incidence of pneumonia with epidural analgesia remained about 8% but decreased from 34% to 12% with systemic analgesia (P Ͻ.001); consequently, the relative benefit of epidural analgesia decreased also. Epidural analgesia reduced the need for prolonged ventilation or reintubation, improved lung function and blood oxygenation, and increased the risk of hypotension, urinary retention, and pruritus. Technical failures occurred in 7%. Conclusion:Epidural analgesia protects against pneumonia following abdominal or thoracic surgery, although this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.

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Thoracic Epidural Anesthesia for Cardiac Surgery: The Effects on Tracheal Intubation Time and Length of Hospital Stay

Abstract: We found that epidural analgesia was more effective than IV morphine for cardiac surgery. Epidural anesthesia also allowed earlier weaning from mechanical ventilation, but it did not affect hospital discharge time.

Cited by 66 publications

References 17 publications

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epiduralbased anesthesia

Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery

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