1
|
Rubio G, Ibekwe SO, Anton J, Tolpin D. Pro: Regional Anesthesia for Cardiac Surgery With Sternotomy. J Cardiothorac Vasc Anesth 2023; 37:1042-1045. [PMID: 36775746 DOI: 10.1053/j.jvca.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Gabriel Rubio
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute, Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX.
| | - Stephanie Opusunju Ibekwe
- Division of Cardiovascular Anesthesiology at Ben Taub Hospital, Baylor College of Medicine, Houston, TX
| | - James Anton
- Baylor College of Medicine Department of Anesthesiology, Texas Heart Institute, Houston, TX
| | - Daniel Tolpin
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute, Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX
| |
Collapse
|
2
|
Sun L, Li Q, Wang Q, Ma F, Han W, Wang M. Bilateral thoracic paravertebral block combined with general anesthesia vs. general anesthesia for patients undergoing off-pump coronary artery bypass grafting: a feasibility study. BMC Anesthesiol 2019; 19:101. [PMID: 31185919 PMCID: PMC6560727 DOI: 10.1186/s12871-019-0768-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Whether thoracic paravertebral block (PVB) is useful in patients undergoing off-pump coronary artery bypass grafting (OPCABG) remains unknown. This study aimed to investigate the feasibility of bilateral PVB combined with general anesthesia (GA) in patients undergoing OPCABG. METHODS This feasibility study assessed 60 patients scheduled for OPCABG at the Qingdao Municipal Hospital in 2016-2017. Patients were randomly assigned to receive nerve stimulator-guided bilateral PVB combined with GA (PVB + GA) or GA alone (n = 30/group). Patients were asked to rate rest and cough pain hourly after the surgery. The primary endpoint was the visual analogue scale (VAS) pain score within 48 h postoperatively. Secondary endpoints were rescue analgesia and morphine consumption, fentanyl dose within 48 h postoperatively, as well as operative time, time to extubation, intensive care unit (ICU) stay, hospital stay and other postoperative adverse events. RESULTS Both rest and cough pains were lower in the PVB + GA group at 12, 24, 36, and 48 h after surgery compared with the GA group. There were fewer patients who needed rescue analgesia in the PVB + GA group at 12 and 24 h than in the GA group. Morphine consumptions at 24 and 48 h were lower in the PVB + GA group compared with the GA group. Time to extubation (P = 0.035) and ICU stay (P = 0.028) were shorter in the PVB + GA group compared with the GA group. AEs showed no differences between the two groups. CONCLUSIONS Nerve stimulator-guided bilateral thoracic PVB combined with GA in OPCABG is associated with a reduced rescue analgesia and morphine consumption, compared to GA.
Collapse
Affiliation(s)
- Lixin Sun
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, 266011, Shandong, China
| | - Qiujie Li
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, 266011, Shandong, China
| | - Qiang Wang
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, 266011, Shandong, China
| | - Fuguo Ma
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, 266011, Shandong, China
| | - Wei Han
- Department of Respiratory Medicine, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao, 266011, Shandong, China.
| | - Mingshan Wang
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, 266011, Shandong, China
| |
Collapse
|
3
|
Guay J, Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database Syst Rev 2019; 3:CD006715. [PMID: 30821845 PMCID: PMC6396869 DOI: 10.1002/14651858.cd006715.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND General anaesthesia combined with epidural analgesia may have a beneficial effect on clinical outcomes. However, use of epidural analgesia for cardiac surgery is controversial due to a theoretical increased risk of epidural haematoma associated with systemic heparinization. This review was published in 2013, and it was updated in 2019. OBJECTIVES To determine the impact of perioperative epidural analgesia in adults undergoing cardiac surgery, with or without cardiopulmonary bypass, on perioperative mortality and cardiac, pulmonary, or neurological morbidity. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase in November 2018, and two trial registers up to February 2019, together with references and relevant conference abstracts. SELECTION CRITERIA We included all randomized controlled trials (RCTs) including adults undergoing any type of cardiac surgery under general anaesthesia and comparing epidural analgesia versus another modality of postoperative pain treatment. The primary outcome was mortality. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 69 trials with 4860 participants: 2404 given epidural analgesia and 2456 receiving comparators (systemic analgesia, peripheral nerve block, intrapleural analgesia, or wound infiltration). The mean (or median) age of participants varied between 43.5 years and 74.6 years. Surgeries performed were coronary artery bypass grafting or valvular procedures and surgeries for congenital heart disease. We judged that no trials were at low risk of bias for all domains, and that all trials were at unclear/high risk of bias for blinding of participants and personnel taking care of study participants.Epidural analgesia versus systemic analgesiaTrials show there may be no difference in mortality at 0 to 30 days (risk difference (RD) 0.00, 95% confidence interval (CI) -0.01 to 0.01; 38 trials with 3418 participants; low-quality evidence), and there may be a reduction in myocardial infarction at 0 to 30 days (RD -0.01, 95% CI -0.02 to 0.00; 26 trials with 2713 participants; low-quality evidence). Epidural analgesia may reduce the risk of 0 to 30 days respiratory depression (RD -0.03, 95% CI -0.05 to -0.01; 21 trials with 1736 participants; low-quality evidence). There is probably little or no difference in risk of pneumonia at 0 to 30 days (RD -0.03, 95% CI -0.07 to 0.01; 10 trials with 1107 participants; moderate-quality evidence), and epidural analgesia probably reduces the risk of atrial fibrillation or atrial flutter at 0 to 2 weeks (RD -0.06, 95% CI -0.10 to -0.01; 18 trials with 2431 participants; moderate-quality evidence). There may be no difference in cerebrovascular accidents at 0 to 30 days (RD -0.00, 95% CI -0.01 to 0.01; 18 trials with 2232 participants; very low-quality evidence), and none of the included trials reported any epidural haematoma events at 0 to 30 days (53 trials with 3982 participants; low-quality evidence). Epidural analgesia probably reduces the duration of tracheal intubation by the equivalent of 2.4 hours (standardized mean difference (SMD) -0.78, 95% CI -1.01 to -0.55; 40 trials with 3353 participants; moderate-quality evidence). Epidural analgesia reduces pain at rest and on movement up to 72 hours after surgery. At six to eight hours, researchers noted a reduction in pain, equivalent to a reduction of 1 point on a 0 to 10 pain scale (SMD -1.35, 95% CI -1.98 to -0.72; 10 trials with 502 participants; moderate-quality evidence). Epidural analgesia may increase risk of hypotension (RD 0.21, 95% CI 0.09 to 0.33; 17 trials with 870 participants; low-quality evidence) but may make little or no difference in the need for infusion of inotropics or vasopressors (RD 0.00, 95% CI -0.06 to 0.07; 23 trials with 1821 participants; low-quality evidence).Epidural analgesia versus other comparatorsFewer studies compared epidural analgesia versus peripheral nerve blocks (four studies), intrapleural analgesia (one study), and wound infiltration (one study). Investigators provided no data for pulmonary complications, atrial fibrillation or flutter, or for any of the comparisons. When reported, other outcomes for these comparisons (mortality, myocardial infarction, neurological complications, duration of tracheal intubation, pain, and haemodynamic support) were uncertain due to the small numbers of trials and participants. AUTHORS' CONCLUSIONS Compared with systemic analgesia, epidural analgesia may reduce the risk of myocardial infarction, respiratory depression, and atrial fibrillation/atrial flutter, as well as the duration of tracheal intubation and pain, in adults undergoing cardiac surgery. There may be little or no difference in mortality, pneumonia, and epidural haematoma, and effects on cerebrovascular accident are uncertain. Evidence is insufficient to show the effects of epidural analgesia compared with peripheral nerve blocks, intrapleural analgesia, or wound infiltration.
Collapse
Affiliation(s)
- Joanne Guay
- University of SherbrookeDepartment of Anesthesiology, Faculty of MedicineSherbrookeQuebecCanada
- University of Quebec in Abitibi‐TemiscamingueTeaching and Research Unit, Health SciencesRouyn‐NorandaQCCanada
- Faculty of Medicine, Laval UniversityDepartment of Anesthesiology and Critical CareQuebec CityQCCanada
| | - Sandra Kopp
- Mayo Clinic College of MedicineDepartment of Anesthesiology and Perioperative Medicine200 1st St SWRochesterMNUSA55901
| | | |
Collapse
|
4
|
Sen AC, Rajan S, Balachandran R, Kumar L, Nair SG. Comparison of Perioperative Thoracic Epidural Fentanyl with Bupivacaine and Intravenous Fentanyl for Analgesia in Patients Undergoing Coronary Artery Bypass Grafting Surgery. Anesth Essays Res 2017; 11:105-109. [PMID: 28298766 PMCID: PMC5341684 DOI: 10.4103/0259-1162.186613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Two-thirds of patients undergoing coronary artery bypass grafting (CABG) surgery report moderate to severe pain, particularly with ambulatory or respiratory effort. AIMS The aim of this study is to compare the analgesic effect of perioperative thoracic epidural fentanyl with bupivacaine and intravenous fentanyl in patients undergoing CABG surgery. SETTINGS AND DESIGN The study was a prospective, randomized, nonblinded comparative study. MATERIALS AND METHODS A total of 60 patients coming under the American Society of Anesthesiologists Class III who were posted for CABG surgery were recruited in this study. The patients were randomized into one of two groups, higher thoracic epidural analgesia (HTEA) group receiving general anesthesia with thoracic epidural analgesia (TEA) in the postoperative period, and intravenous fentanyl analgesia group receiving general anesthesia with fentanyl infusion in the postoperative period. The pain was assessed at 4 h after extubation when the patient was fully awake, then at 8, 12, 18, and 24 h. Both groups received intravenous tramadol 100 mg as rescue analgesia whenever visual analog scale score was 5 and above. Heart rate, mean arterial pressure (MAP), sedation scores, and physiotherapy cooperation were also assessed. STATISTICAL ANALYSIS USED The numerical data were analyzed using an independent t-test, repeated-measures ANOVA, and Mann-Whitney U-test. RESULTS Pain at rest and on cough was significantly lower in HTEA patients as compared to control group. Patients HTEA group got less frequent rescue analgesia than the control group. Physiotherapy cooperation was significantly better in HTEA patients at 4, 12, and 24 h postextubation. They also had significantly lower heart rate, MAP, and sedation scores. CONCLUSION Perioperative TEA using fentanyl with bupivacaine provided optimal postoperative analgesia at rest and during coughing in patients following CABG surgery as compared to postoperative analgesia with intravenous fentanyl. It also resulted in optimal postoperative hemodynamic status, good cooperation to chest physiotherapy with less sedation.
Collapse
Affiliation(s)
- Amitabh Chanchal Sen
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rakhi Balachandran
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Suresh Gangadharan Nair
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| |
Collapse
|
5
|
Mehta Y, Arora D. Benefits and Risks of Epidural Analgesia in Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:1057-63. [DOI: 10.1053/j.jvca.2013.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Indexed: 11/11/2022]
|
6
|
Liang Y, Chu H, Zhen H, Wang S, Gu M. A prospective randomized study of intraoperative thoracic epidural analgesia in off-pump coronary artery bypass surgery. J Anesth 2012; 26:393-9. [PMID: 22274169 DOI: 10.1007/s00540-012-1325-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 01/03/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The purpose of this study was to test the hypothesis that general anesthesia (GA) plus thoracic epidural anesthesia (TEA) has no impact on the outcomes of off-pump coronary artery bypass surgery (OPCABs) compared to GA followed by patient-controlled TEA (PCTEA), while GA plus TEA leads to a higher requirement for vasoactive drug use. METHODS Sixty-four patients, American Society of Anesthesiologists physical status II and III, who were scheduled for elective OPCABs, were offered an epidural catheter inserted at the T2-3 interspace and then randomized into 1 of 2 groups according to whether TEA was applied intraoperatively. The TEA(perio) group received GA plus TEA, while the TEA(post) group received GA alone. All groups had postoperative PCTEA. The number of requirements for vasoactive drugs and the extubation times were recorded. The analgesic effect was monitored by visual analog scale (VAS) pain scores. Heart rate, blood pressure, and blood gases were also monitored. The data are presented as mean values ± standard deviation, or medians with quartiles. RESULTS The proportion of vasoactive drug use was significantly higher in the TEA(perio) group intraoperatively (before or during completion of anastomoses: 59.4 vs. 20.7%, p = 0.004; after completion of anastomoses: 53.1 vs. 17.2%, p = 0.007). There was no statistically significant difference in extubation times or VAS scores between the 2 groups. CONCLUSIONS We conclude that GA plus TEA has no impact on the outcomes of OPCABs, while its use leads to a higher requirement for vasoactive drug use. GA followed by PCTEA facilitates the anesthesia administration, while it does not affect the extubation time and the postoperative analgesic effect.
Collapse
Affiliation(s)
- Yongxin Liang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, People's Republic of China
| | | | | | | | | |
Collapse
|
7
|
El-Morsy GZ, El-Deeb A. The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery. Saudi J Anaesth 2012; 6:16-21. [PMID: 22412771 PMCID: PMC3299108 DOI: 10.4103/1658-354x.93048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Thoracic epidural anesthesia (TEA) improves analgesia and outcomes after a cardiac surgery. As aging is a risk factor for postoperative pulmonary complications, TEA is of particular importance in elderly patients undergoing coronary artery bypass graft (CABG). METHODS Fifty patients aged 65-75 years; ASA II and III scheduled for elective CABG were included in the study. Patients were randomized to receive either general anesthesia (GA) group alone or GA combined with TEA group. Heart rate (HR), mean arterial pressure (MAP), and central venous pressure were recorded. Total dose of fentanyl μg/kg, aortic cross clamping, cardiopulmonary bypass (CPB) time, time to first awaking and extubation, arterial blood gases, visual analog scale (VAS) score in intensive care unit were reported. Postoperative pulmonary function tests were done. RESULTS TEA showed a significant HR and lower MAP compared with the GA group. The total dose of intraoperative fentanyl and nitroglycerine were significantly lower in the TEA. Patients in TEA group have statistically significantly higher PaO(2), lower PaCO(2), increase in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV(1)) CONCLUSIONS TEA reduced severity of postoperative pulmonary function and restoration was faster in TEA group in elderly patients undergoing CABG. Also, it resulted in earlier extubation and awakening, better analgesia, lower VAS.
Collapse
Affiliation(s)
- Gamal Z. El-Morsy
- Department of Anesthesia, Faculty of Medicine, Mansoura University, Egypt
| | - Alaa El-Deeb
- Department of Anesthesia, Faculty of Medicine, Mansoura University, Egypt
| |
Collapse
|
8
|
Rama-Maceiras P, Díaz-Allegue M, Pato-López O, Ramos-López L, Rey-Rilo T, Bonome-González C. [Perioperative treatment of a man receiving a left-lung transplant combined with coronary revascularization without use of extracorporeal circulation: with a brief review of pathophysiology and the literature]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:425-430. [PMID: 20857638 DOI: 10.1016/s0034-9356(10)70269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patients with significant coronary artery disease were once traditionally rejected as candidates for lung transplants because of higher risk of morbidity and mortality. We report the case of a man who received a left lung transplant and coronary revascularization without extracorporeal circulation in a combined surgical procedure after being diagnosed with significant coronary disease during the preoperative study for acceptance as a candidate for lung transplantation. We review the history of such combination procedures, which are changing clinicians' attitudes as to appropriate therapeutic approaches to take for complex patients. We also discuss the possible advantages of performing surgery without extracorporeal circulation. To our knowledge, this is the first report of a combined procedure that took place in a Spanish hospital.
Collapse
Affiliation(s)
- P Rama-Maceiras
- Servicio de Anestesiología y Reanimación. Complejo Hospitalario Universitario. A Coruña.
| | | | | | | | | | | |
Collapse
|
9
|
Liang YX, Gu MN, Wang SD, Chu HC. Thoracic epidural anesthesia and coronary artery bypass surgery: what clinicians have learned from clinical trials. J Cardiothorac Vasc Anesth 2010; 25:388. [PMID: 20427205 DOI: 10.1053/j.jvca.2010.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Indexed: 11/11/2022]
|
10
|
Kim MH, Lim YJ, Hong DM, Jeon YS, Park HP, Jeon YT, Shin SY, Han SS. Spreading pattern of contrast medium in the high thoracic epidural space in rabbits: the effect of neck flexion and extension. Korean J Anesthesiol 2010; 59:111-5. [PMID: 20740216 PMCID: PMC2926426 DOI: 10.4097/kjae.2010.59.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/14/2010] [Accepted: 06/17/2010] [Indexed: 11/11/2022] Open
Abstract
Background Neck flexion has been shown to increase cranial spread of contrast agent when a small fixed volume was injected into the high thoracic epidural space. The purpose of this study was to evaluate the effect of volume of contrast medium on its distribution through the high thoracic epidural space during neck extension and flexion using the rabbit model. Methods An epidural catheter was introduced into the epidural space of New Zealand white rabbits with the tip located at the T3-4 intervertebral level. The neck was extended or flexed (n = 8 for each group), and the contrast medium was injected with the volume increasing by increments of 0.1 ml/kg, up to 0.3 ml/kg. The spread of contrast medium was determined by counting the number of vertebral body units using lateral epidurographic images. Results In both groups, the total spread of contrast medium was similar, increasing continuously with injected volume. The cranial spread was greater in the flexion group than the extension group. However, the caudal spread was greater in the extension than in the flexion group. In the extension group, the contrast medium spread caudally about twice as far as it spread cranially, but there was no statistically significant difference between cranial and caudal spread in the flexion group. Conclusions In the high thoracic epidural space of rabbit, the contrast medium of varying doses showed limited cranial spread. The flexion of the neck increased cranial spread and extension of the neck increased caudal spread.
Collapse
Affiliation(s)
- Mi-Hyun Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Deok-Man Hong
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yun-Seok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon Young Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Sook Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
11
|
Visser WA, Lee RA, Gielen MJM. Factors Affecting the Distribution of Neural Blockade by Local Anesthetics in Epidural Anesthesia and a Comparison of Lumbar Versus Thoracic Epidural Anesthesia. Anesth Analg 2008; 107:708-21. [DOI: 10.1213/ane.0b013e31817e7065] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
12
|
Noiseux N, Prieto I, Bracco D, Basile F, Hemmerling T. Coronary artery bypass grafting in the awake patient combining high thoracic epidural and femoral nerve block: first series of 15 patients. Br J Anaesth 2008; 100:184-9. [DOI: 10.1093/bja/aem370] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
13
|
Mason DP, Marsh DH, Alster JM, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Atrial Fibrillation After Lung Transplantation: Timing, Risk Factors, and Treatment. Ann Thorac Surg 2007; 84:1878-84. [DOI: 10.1016/j.athoracsur.2007.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 07/05/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
|
14
|
Salvi L, Sisillo E, Rondello N. Success Rate, Decubitus Position, and Vagal Reflex During a High Thoracic Epidural for Coronary Artery Surgery. J Cardiothorac Vasc Anesth 2007; 21:919-20. [DOI: 10.1053/j.jvca.2007.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Indexed: 11/11/2022]
|
15
|
Salvi L, Parolari A, Veglia F, Brambillasca C, Gregu S, Sisillo E. High Thoracic Epidural Anesthesia in Coronary Artery Bypass Surgery: A Propensity-Matched Study. J Cardiothorac Vasc Anesth 2007; 21:810-5. [DOI: 10.1053/j.jvca.2006.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Indexed: 11/11/2022]
|
16
|
Homi HM, Sulzer C, Lappas G, D'Amico T, Stafford-Smith M. Suitability of the Lumbar Test Dose for the Thoracic Epidural Space. J Cardiothorac Vasc Anesth 2006; 20:700-3. [PMID: 17023292 DOI: 10.1053/j.jvca.2006.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Indexed: 11/11/2022]
Affiliation(s)
- H Mayumi Homi
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | |
Collapse
|
17
|
Wynn MM, Mittnacht A, Norris E. Con: Surgery Should Not Proceed When a Bloody Tap Occurs During Spinal Drain Placement for Elective Thoracoabdominal Aortic Surgery. J Cardiothorac Vasc Anesth 2006; 20:273-5. [PMID: 16616676 DOI: 10.1053/j.jvca.2005.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Indexed: 11/11/2022]
MESH Headings
- Aortic Aneurysm, Abdominal/complications
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/surgery
- Contraindications
- Elective Surgical Procedures
- Hematoma, Epidural, Spinal/cerebrospinal fluid
- Hematoma, Epidural, Spinal/diagnosis
- Hematoma, Subdural, Spinal/cerebrospinal fluid
- Hematoma, Subdural, Spinal/diagnosis
- Humans
- Risk Factors
- Spinal Puncture
- Vascular Surgical Procedures
Collapse
Affiliation(s)
- Martha M Wynn
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
| | | | | |
Collapse
|
18
|
Alvarez J, Hernández B, Atanassoff PG. High thoracic epidural anesthesia and coronary artery disease in surgical and non-surgical patients. Curr Opin Anaesthesiol 2005; 18:501-6. [PMID: 16534283 DOI: 10.1097/01.aco.0000183104.73931.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Even though high thoracic epidural anesthesia has been shown to be highly efficacious in the control of symptoms in refractory angina, its general use is still restricted. In patients who undergo coronary revascularization, however, the technique is becoming more and more popular. The present review outlines the use of high thoracic epidural anesthesia in patients with ischemic heart disease who underwent coronary revascularization in order to further reveal high thoracic epidural anesthesia's low complication rate and to analyze why physicians still refrain from using it more frequently. RECENT FINDINGS The incidence of severe hemodynamic complications after high thoracic epidural anesthesia is low in patients with coronary artery disease. The main advantage would be a myocardial sympathectomy leading to an improvement in the oxygen input-demand relationship. Likewise, a decrease in mortality due to respiratory complications could not be shown. In patients undergoing myocardial revascularization with full anticoagulation there is an increased risk of epidural hematoma formation. Its precise risk is difficult to evaluate. There is an overall low rate of epidural hematomas as a result of high thoracic epidural anesthesia. With the available data, the incidence has been estimated at between 1/1500 and 1/10,000. SUMMARY Epidural anesthesia does not decrease mortality or the incidence of myocardial infarction after coronary artery bypass grafting. It reduces the incidence of arrhythmias and respiratory complications and improves the quality of analgesia. High thoracic epidural anesthesia has been shown to be a safe and efficient technique for refractory angina that reduces the frequency of ischemic events and improves the clinical condition of patients.
Collapse
Affiliation(s)
- Julian Alvarez
- Department of Anesthesia, University Hospital, Santiago de Compostela, Spain.
| | | | | |
Collapse
|
19
|
|