Thoracic epidural analgesia and coronary artery bypass grafting

Conscious Cardiac Surgery With Cardiopulmonary Bypass Using Thoracic Epidural Anesthesia Without Endotracheal General Anesthesia

OBJECTIVE

The purpose of this study was to evaluate the feasibility of thoracic epidural anesthesia as an alternative technique to general anesthesia in patients undergoing cardiac surgery under cardiopulmonary bypass.

DESIGN

A prospective study.

SETTING

Tertiary referral heart hospital.

PARTICIPANTS

Eleven patients underwent cardiac surgical procedures requiring cardiopulmonary bypass under thoracic epidural anesthesia from February to April 2004.

INTERVENTIONS

An epidural catheter was inserted at C7 to T2 intervertebral space on the day before the operation. Subsequently, cardiac surgery was performed using cardiopulmonary bypass.

MEASUREMENTS AND RESULTS

The midsternotomy approach was used in all the patients. Anticoagulation was achieved with 300 units/kg of heparin. Under normothermic cardiopulmonary bypass, 6 patients underwent closure of atrial septal defect, 3 underwent valve replacements, and 2 underwent coronary artery bypass surgery combined with valve replacements. Soon after establishing cardiopulmonary bypass, all but 1 patient developed apnea, which was reversed after termination of cardiopulmonary bypass. The mean cardiopulmonary bypass time was 102 +/- 28 minutes, the aortic cross-clamp time was 58 +/- 28 minutes, and the total duration of surgery was 229 +/- 64 minutes. There was no mortality or morbidity in this series.

CONCLUSION

Cardiac surgical procedures requiring cardiopulmonary bypass may be performed under thoracic epidural anesthesia, without endotracheal general anesthesia.

Thoracic epidural anesthesia in cardiac surgical patients: A prospective audit of 2,113 cases

OBJECTIVE

The purpose of this study was to present an audit report of thoracic epidural anesthesia without permanent neurologic deficits in more than 2,000 patients undergoing cardiac surgery.

DESIGN

A prospective audit of cases conducted over a 13-year period.

SETTING

Tertiary referral heart hospital.

PARTICIPANTS

Two thousand one hundred thirteen patients over a period of 13 years.

INTERVENTIONS

Epidural catheters were inserted at the C7 to T3 intervertebral space on the day before the operation in all patients; cardiac surgery was performed with or without cardiopulmonary bypass.

MEASUREMENTS AND RESULTS

The authors did not encounter any permanent neurologic deficits in their series. The authors encountered 18 (0.85%) primary dural punctures and 4 cases (0.18%) of temporary neurologic deficits.

CONCLUSION

This series adds to the worldwide experience of the use of epidural analgesia concomitantly with anticoagulation in cardiac surgery without serious complications.