1
|
Laferrière-Langlois P, Jeffries S, Harutyunyan R, Hemmerling TM. Epidural Catheterization in Cardiac Surgery: A Systematic Review and Risk Assessment of Epidural Hematoma. Ann Card Anaesth 2024; 27:111-120. [PMID: 38607874 PMCID: PMC11095789 DOI: 10.4103/aca.aca_160_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 04/14/2024] Open
Abstract
ABSTRACT The potential benefits of epidural anesthesia on mortality, atrial fibrillation, and pulmonary complications must be weighed against the risk of epidural hematoma associated with intraoperative heparinization. This study aims to provide an updated assessment of the clinical risks of epidural anesthesia in cardiac surgery, focusing on the occurrence of epidural hematomas and subsequent paralysis. A systematic search of Embase, Medline, Ovid Central, Web of Science, and PubMed was conducted to identify relevant publications between 1966 and 2022. Two independent reviewers assessed the eligibility of the retrieved manuscripts. Studies reporting adult patients undergoing cardiac surgery with epidural catheterization were included. The incidence of hematomas was calculated by dividing the number of hematomas by the total number of patients in the included studies. Risk calculations utilized various denominators based on the rigor of trial designs, and the risks of hematoma and paralysis were compared to other commonly encountered risks. The analysis included a total of 33,089 patients who underwent cardiac surgery with epidural catheterization. No epidural hematomas were reported across all published RCTs, prospective, and retrospective trials. Four case reports associated epidural hematoma with epidural catheterization and perioperative heparinization. The risks of epidural hematoma and subsequent paralysis were estimated at 1:7643 (95% CI 1:3860 to 380,916) and 1:10,190 (95% CI 1:4781 to 0:1), respectively. The risk of hematoma is similar to the non-obstetric population (1:5405; 95% CI 1:4784 to 6134). The risk of hematoma in cardiac surgery patients receiving epidural anesthesia is therefore similar to that observed in some other surgical non-obstetric populations commonly exposed to epidural catheterization.
Collapse
Affiliation(s)
- Pascal Laferrière-Langlois
- Department of Anaesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l’Est de L’Ile de Montréal, Montréal, Québec, Canada
| | - Sean Jeffries
- Department of Experimental Surgery, McGill University Health Centre, Montréal, Canada
- Intelligent Technology Anaesthesia Group (ITAG) Laboratory, McGill University, Montréal, Canada
| | - Robert Harutyunyan
- Department of Experimental Surgery, McGill University Health Centre, Montréal, Canada
- Intelligent Technology Anaesthesia Group (ITAG) Laboratory, McGill University, Montréal, Canada
| | - Thomas M. Hemmerling
- Department of Experimental Surgery, McGill University Health Centre, Montréal, Canada
- Intelligent Technology Anaesthesia Group (ITAG) Laboratory, McGill University, Montréal, Canada
| |
Collapse
|
2
|
Kumar A, Ghotra GS, Dwivedi D, Bhargava DV, Joshi A, Tiwari N, Ramamurthy HR. Common Inflammatory Markers and Outcome After Pediatric Cardiac Surgery With High Thoracic Epidural Anesthesia: A Randomized Controlled Study. World J Pediatr Congenit Heart Surg 2023; 14:334-344. [PMID: 36823972 DOI: 10.1177/21501351221151053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background: High thoracic epidural analgesia (HTEA) plays a pivotal role in reducing stress and neuroendocrine response in cardiac surgeries. Aim: The primary objective is to assess the effect of HTEA, in pediatric cardiac surgery, on inflammatory markers (interleukin [IL]-6, IL-8, and tumor necrosis factor-α). The secondary objectives are to assess its effect on various organ systems, that is, pulmonary (PaO2, P/F ratio), renal (Creatinine clearance, somatic near infrared spectroscopy [NIRS], serum neutrophil gelatinase-associated lipocalin values), cardiac (cardiac index, serum Trop-I, and lactate levels), mechanical ventilation duration, and length of stay in hospital (LOS). Methods: The study included 188 pediatric patients, who underwent, on-pump cardiac surgery randomized into the Epidural Group (n = 92) and Non-Epidural Group (n = 96). After general anesthesia, a 23 G epidural catheter was placed at the T4-5 level with a Bupivacaine infusion while the Non-epidural Group received fentanyl infusion. Blood samples were collected at four-time points, T0(preop), T1(4 h), and on the first and second postoperative days (T2 and T3). Results: The inflammatory markers were reduced, while the outcomes variables of mechanical ventilation (MV) duration had lower values in the epidural group (19.5 h vs 47.3 h, P = .002). LOS was shorter (10.1 days vs 13.3 days, P = .016). pO2, PF ratio, and renal NIRS values were better in the Epidural Gp, while other parameters were comparable. Non-epidural Gp had more complications esp. Acute kidney injury requires RRT. Conclusion: HTEA use in pediatric, on-pump cardiac surgery offers a favorable profile in terms of reduction in the inflammatory markers and positive effect on the organ systems with lesser MV duration and the LOS.
Collapse
Affiliation(s)
- Alok Kumar
- Department of Anaesthesia & Critical Care, 521937Army Hospital (Research & Referral), New Delhi, India
| | - Gurpinder Singh Ghotra
- Department of Anaesthesia & Critical Care, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Deepak Dwivedi
- Department of Anaesthesia & Critical Care, Department of Anaesthesia & Critical Care, 30154Command Hospital (Eastern command), Kolkata, India
| | - D V Bhargava
- Department of Anaesthesia & Critical Care, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Ankur Joshi
- Department of Anaesthesia & Critical Care, 521937Army Hospital (Research & Referral), New Delhi, India
| | - Nikhil Tiwari
- Department of Cardiothoracic Surgery, 521937Army Hospital (Research & Referral), New Delhi, India
| | - H R Ramamurthy
- Department of Paediatrics, 521937Army Hospital (Research & Referral), New Delhi, India
| |
Collapse
|
3
|
Thalji NK, Patel SJ, Augoustides JG, Schiller RJ, Dalia AA, Low Y, Hamzi RI, Fernando RJ. Opioid-Free Cardiac Surgery: A Multimodal Pain Management Strategy With a Focus on Bilateral Erector Spinae Plane Block Catheters. J Cardiothorac Vasc Anesth 2022; 36:4523-4533. [PMID: 36184473 PMCID: PMC9745636 DOI: 10.1053/j.jvca.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Nabil K Thalji
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Jayant Patel
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robin J Schiller
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Adam A Dalia
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Yinghui Low
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Rawad I Hamzi
- Department of Anesthesiology, Regional Anesthesia and Acute Pain Management, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| |
Collapse
|
4
|
Saha SK, Ranjan R, Adhikary AB. Comparison of traditional and upper thoracic epidural analgesia after off-pump coronary artery bypass graft surgery: A Quasi-experimental study. Health Sci Rep 2022; 5:e774. [PMID: 35957975 PMCID: PMC9364326 DOI: 10.1002/hsr2.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Aims Surgical trauma initiates changes in central and peripheral nervous systems that need to be treated therapeutically to facilitate postoperative pain. The quality of postoperative analgesia is expected to affect clinical outcomes positively. Albeit optimal pain relief following cardiac surgery is often complex, researchers have tried to explore several techniques other than conventional ones during the last decade to find a unique analgesic method for postcardiac surgical patients. This study aims to find a unique analgesic approach that maximizes patient satisfaction after off-pump coronary artery bypass graft (OPCABG) surgery. Methods The current study will compare the analgesic effect of upper thoracic epidural analgesia (TEA) with conventional analgesia after OPCAB graft surgery. For this, we will use a Quasi-experimental study design. Patients admitted for coronary artery bypass graft (CABG) surgery will be assigned into two groups. The control group (conventional) will receive intravenous opioids and nonsteroidal anti-inflammatory medications, and the study (case) group (TEA) will receive Inj. Bupivacaine 0.25% as an infusion through the epidural catheter. Physiologic parameters like hemodynamic and respiratory variables and pain scores will be recorded in predesigned format periodically. Results We expect to analyze a total of 130 consecutive off-pump CABG surgery patients in Group A (Case, 65 patients) and Group B (Control, 65 patients). Study variables will be the visual analog scale score, hemodynamic parameters (heart rate, mean arterial pressure, and respiratory parameters (respiratory rate, PaO2, PaCO2, PEFR, FEV1). After data collection, the result will be analyzed and published in the public domain and in journals. Conclusion We expect thoracic epidural analgesia with local anesthetics will be a reliable postoperative analgesic option.
Collapse
Affiliation(s)
- Sanjoy Kumar Saha
- Bangladesh University of ProfessionalsDhakaBangladesh
- Bangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | - Redoy Ranjan
- Bangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
- Royal Holloway University of LondonEghamUK
| | | |
Collapse
|
5
|
Krakowski JC, Hallman MJ, Smeltz AM. Persistent Pain After Cardiac Surgery: Prevention and Management. Semin Cardiothorac Vasc Anesth 2021; 25:289-300. [PMID: 34416847 PMCID: PMC8669213 DOI: 10.1177/10892532211041320] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Persistent postoperative pain (PPP) after cardiac surgery is a significant complication that negatively affects patient quality of life and increases health care system burden. However, there are no standards or guidelines to inform how to mitigate these effects. Therefore, in this review, we will discuss strategies to prevent and manage PPP after cardiac surgery. Adequate perioperative analgesia may prove instrumental in the prevention of PPP. Although opioids have historically been the primary analgesic approach to cardiac surgery, an opioid-sparing strategy may prove advantageous in reducing side effects, avoiding secondary hyperalgesia, and decreasing risk of PPP. Implementing a multimodal analgesic plan using alternative medications and regional anesthetic techniques may offer superior efficacy while reducing adverse effects.
Collapse
Affiliation(s)
| | | | - Alan M Smeltz
- University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|
6
|
Devarajan J, Balasubramanian S, Nazarnia S, Lin C, Subramaniam K. Current Status of Neuraxial and Paravertebral Blocks for Adult Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2021; 25:252-264. [PMID: 34162252 DOI: 10.1177/10892532211023337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac surgeries are known to produce moderate to severe pain. Pain management has traditionally been based on intravenous opioids. Poorly controlled pain can result in increased incidence of respiratory complications such as atelectasis and pneumonia leading to prolonged intubation and intensive care unit length of stay and subsequent prolonged hospital stay. Adequate perioperative analgesia improves hemodynamics and immunologic responses, which would result in better outcomes after cardiac surgery. Opioid sparing "Enhanced Recovery After Surgery" protocols are increasingly being incorporated into cardiac surgeries. This will reduce opioid requirements and opioid-related side effects and facilitate fast-tracking of patients. Regional analgesia can be provided by neuraxial blocks, fascial plane blocks, peripheral nerve blocks, or simply by the infiltration of the wound with local anesthetics for cardiac surgery. Neuraxial analgesia is provided through epidural, spinal, and paravertebral routes. Though they are being replaced by peripheral fascial plane blocks, epidural and spinal analgesia are still being used in some centers. In this article, neuraxial forms of analgesia are focused. We sought to review epidural analgesia and its impact in suppressing hemodynamic stress response, reducing pulmonary complications, and development of chronic pain. The relationship between intraoperative heparinization and potential neuraxial hematoma is discussed. Other neuraxial options such as spinal and paravertebral analgesia and their usefulness, benefits, and limitations are also reviewed.
Collapse
Affiliation(s)
| | | | | | - Charles Lin
- University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
7
|
Chaney MA. So You Want to Write a Narrative Review Article? J Cardiothorac Vasc Anesth 2021; 35:3045-3049. [PMID: 34272117 DOI: 10.1053/j.jvca.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| |
Collapse
|
8
|
Elmiro GS, Souza AHD, Loyola SDO, Prudente ML, Kushida CL, Carvalho JOD, Zumpano F, Gardenghi G. Spinal Anesthesia Increases the Frequency of Extubation in the Operating Room and Decreases the Time of Mechanical Ventilation after Cardiac Surgery. Braz J Cardiovasc Surg 2021; 36:32-38. [PMID: 33355784 PMCID: PMC7918398 DOI: 10.21470/1678-9741-2019-0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. METHODS Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. RESULTS In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group (P=0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs. GA: 6.0±5.6 hours, P=0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR (P=0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs. 1.7±3.9 hours in the SA group (P=0.04). CONCLUSION The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.
Collapse
Affiliation(s)
| | | | | | | | - Celina Lumi Kushida
- Department of Intensive Care Unit, ENCORE Hospital, Aparecida de Goiânia, Goiás, Brazil
| | | | - Fabiano Zumpano
- Department of Anesthesiology Service, ENCORE Hospital, Aparecida de Goiânia, Goiás, Brazil
| | - Giulliano Gardenghi
- Department of Scientific Coordination, ENCORE Hospital, Aparecida de Goiânia, Goiás, Brazil
| |
Collapse
|
9
|
Krakowski JC, Arora H. Con: General Anesthesia Is Not Superior to Regional Anesthesia for Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery. J Cardiothorac Vasc Anesth 2021; 35:1888-1891. [PMID: 33478879 DOI: 10.1053/j.jvca.2020.12.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022]
Affiliation(s)
- James C Krakowski
- Department of Anesthesiology, University of North Carolina School of Medicine, UNC Hospitals, Chapel Hill, NC.
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine, UNC Hospitals, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| |
Collapse
|
10
|
Lu SY, Lai Y, Dalia AA. Implementing a Cardiac Enhanced Recovery After Surgery Protocol: Nuts and Bolts. J Cardiothorac Vasc Anesth 2020; 34:3104-3112. [DOI: 10.1053/j.jvca.2019.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/02/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
|
11
|
Vilvanathan S, Saravanababu MS, Sreedhar R, Gadhinglajkar SV, Dash PK, Sukesan S. Ultrasound-guided Modified Parasternal Intercostal Nerve Block: Role of Preemptive Analgesic Adjunct for Mitigating Poststernotomy Pain. Anesth Essays Res 2020; 14:300-304. [PMID: 33487833 PMCID: PMC7819423 DOI: 10.4103/aer.aer_32_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/29/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aim To assess the quality and effectiveness of postoperative pain relief after fast-tracking tracheal extubation in cardiac surgery intensive care unit, effected by a single-shot modified parasternal intercostal nerve block compared with routine in-hospital analgesic protocol, when administered before sternotomy. Design A prospective, randomized, double-blinded interventional study. Setting Single-center tertiary teaching hospital. Participants Ninety adult patients undergoing elective coronary artery bypass grafting surgery under cardiopulmonary bypass. Materials and Methods Patients were randomized into two groups. Patients in the parasternal intercostal block group (PIB) (n = 45) received ultrasound-guided modified parasternal intercostal nerve block with 0.5% levobupivacaine after anesthesia induction at 2nd-6th intercostal space along postinduction using standardized anesthesia drugs with routine postoperative hospital analgesic protocol with intravenous morphine. Patients in the group following routine hospital analgesia protocol (HAP) (n = 45) served as controls, with standardized anesthesia drugs and routine hospital postoperative analgesic protocol with intravenous morphine. The primary study outcome aimed to evaluate pain at rest and when doing deep breathing exercises with spirometry, coughing expectorations using a 11-point numerical rating scale. Results The postoperative pain score at rest and during breathing exercises was compared between the two groups at different time durations (15 min after extubation and every 4th hourly for 24 h). Patients in the PIB group had significantly lower pain scores and better quality of analgesia during the entire study period at rest and during breathing exercise (P < 0.0001). Furthermore, the side effect profile and need of rescue analgesics were better in the PIB group than the HAP group at different time intervals. Conclusion PIB is safe for presternotomy administration and provided significant quality of pain relief postoperatively, as seen after tracheal extubation for a period of 24 h, on rest as well as with deep breathing, coughing, and chest physiotherapy exercises when compared to intravenous morphine alone after sternotomy. This study further emphasizes the role of preemptive analgesia in mitigating postoperative sternotomy pain and it's role as a plausible safe analgesic adjunct facilitating fast tracking with sternotomies on systemic heparinization.
Collapse
Affiliation(s)
- Santhosh Vilvanathan
- Department of Anaesthesiology, Division of Cardiothroracic and Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M S Saravanababu
- Department of Anaesthesiology, Division of Cardiothroracic and Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rupa Sreedhar
- Department of Anaesthesiology, Division of Cardiothroracic and Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Shinivas Vitthal Gadhinglajkar
- Department of Anaesthesiology, Division of Cardiothroracic and Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Prasanta Kumar Dash
- Department of Anaesthesiology, Division of Cardiothroracic and Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Subin Sukesan
- Department of Anaesthesiology, Division of Cardiothroracic and Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
12
|
Regional anesthesia considerations for cardiac surgery. Best Pract Res Clin Anaesthesiol 2019; 33:387-406. [DOI: 10.1016/j.bpa.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/22/2023]
|
13
|
Hanada S, Kurosawa A, Randall B, Van Der Horst T, Ueda K. Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study. Reg Anesth Pain Med 2019; 45:22-26. [PMID: 31772035 DOI: 10.1136/rapm-2018-100213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Although high spinal anesthesia (HSA) has been used in cardiac surgery, the technique has not yet been widely accepted. This retrospective study was designed to investigate the impact of HSA technique on fast-track strategy in cardiac surgery. METHODS Elective cardiac surgery cases (n=1025) were divided into two groups: cases with HSA combined with general anesthesia (GA) (HSA group, n=188) and cases with GA only (GA group, n=837). In the HSA group, bupivacaine and morphine were intrathecally administered immediately before GA was induced. Outcomes included fast-track extubation (less than 6 hours), extubation in the operating room, fast-track discharge from the intensive care unit (ICU) (less than 48 hours) and hospital (less than 7 days). RESULTS In the HSA group, 60.1% were extubated in less than 6 hours after ICU admission, as compared with 39.9% in the GA group (p<0.001). In the HSA group, 33.0% were extubated in the operating room, as compared with 4.4% in the GA group (p<0.001). LOS in the ICU was less than 48 hours in 67.6% in the HSA group, as compared with 57.2% of those in the GA group (p=0.033). LOS in the hospital was less than 7 days in 63.3% in the HSA group, as compared with 53.5% in the GA group (p=0.084). CONCLUSIONS HSA technique combined with GA in cardiac surgery increased the rate of fast-track extubation (less than 6 hours) when compared with GA only.
Collapse
Affiliation(s)
- Satoshi Hanada
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Atsushi Kurosawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Benjamin Randall
- Mountain West Anesthesia, Intermountain Medical Center, Murray, Utah, USA
| | - Theodore Van Der Horst
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | - Kenichi Ueda
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
14
|
Yu S, Valencia MB, Roques V, Aljure OD. Regional analgesia for minimally invasive cardiac surgery. J Card Surg 2019; 34:1289-1296. [DOI: 10.1111/jocs.14177] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Soojie Yu
- Department of AnesthesiologyJackson Memorial Hospital/University of MiamiMiami Florida
| | - Marta Berrio Valencia
- Department of Cardiac and Transplant AnesthesiologyLondon Health Sciences CentreLondon Ontario Canada
| | - Vicente Roques
- Department of Intensive Care and Chronic Pain TreatmentUniversity Hospital Virgen de la ArrixacaMurcia Spain
| | - Oscar David Aljure
- Department of AnesthesiologyJackson Memorial Hospital/University of MiamiMiami Florida
| |
Collapse
|
15
|
Kwanten LE, O'Brien B, Anwar S. Opioid-Based Anesthesia and Analgesia for Adult Cardiac Surgery: History and Narrative Review of the Literature. J Cardiothorac Vasc Anesth 2019; 33:808-816. [DOI: 10.1053/j.jvca.2018.05.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/04/2023]
|
16
|
Jellish WS, Oftadeh M. Enhanced Recovery After Surgery for Cardiac Surgery: Will We Have the Techniques Needed to Reduce Opioid Use and Still Provide Appropriate Analgesia? J Cardiothorac Vasc Anesth 2019; 33:547-548. [DOI: 10.1053/j.jvca.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Indexed: 11/11/2022]
|
17
|
Royse CF, Soeding PF, Royse AG. High Thoracic Epidural Analgesia for Cardiac Surgery: An Audit of 874 Cases. Anaesth Intensive Care 2019; 35:374-7. [PMID: 17591131 DOI: 10.1177/0310057x0703500309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite clinical use for over 10 years, high thoracic epidural analgesia for cardiac surgery remains controversial, due to a perceived increased risk of epidural haematoma resulting from anticoagulation for cardiac pulmonary bypass. There are no sufficiently large randomised studies to address this question and few large case series reported. For this reason, we conducted an audit of neurological complications related to high thoracic epidural analgesia during cardiac surgery in our institution between 1998 and end 2005. During this period 874 patients received epidural analgesia. There were no neurological complications attributable to epidural use. Our findings suggest that major neurological complications related to high thoracic epidural use during cardiac surgery are rare.
Collapse
Affiliation(s)
- C F Royse
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Carlton, Victoria, Australia
| | | | | |
Collapse
|
18
|
Chakravarthy M. Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia? Ann Card Anaesth 2018; 21:225-227. [PMID: 30052206 PMCID: PMC6078036 DOI: 10.4103/aca.aca_56_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| |
Collapse
|
19
|
KАBАKOV DG, BАZАROV DV, VYZHIGINА MА, АKSELROD BА, MOROZOVА АА, KАVOCHKIN АА, BELOV YUV. RISK FACTORS OF SIMULTANEOUS SURGERY FOR CONCURRENT LUNG CANCER AND CARDIAC VASCULAR DISORDERS. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2018. [DOI: 10.21292/2078-5658-2018-15-5-87-94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
20
|
Ellenberger C, Sologashvili T, Bhaskaran K, Licker M. Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study. BMC Anesthesiol 2017; 17:109. [PMID: 28830362 PMCID: PMC5567923 DOI: 10.1186/s12871-017-0398-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/10/2017] [Indexed: 11/21/2022] Open
Abstract
Background Acute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery. This study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid administration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs). Methods Data from adult patients who underwent elective cardiac surgery between January 2002, and December 2013 in a single center were analyzed. Propensity scores estimating the likelihood of receiving ITMA were used to match (1:1) patients with ITMA and patients with intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint including pneumonia, adult respiratory distress syndrome, and any type of acute respiratory failure. Secondary outcomes were in-hospital mortality, cardiovascular complications, and length of stay in the intensive care unit (ICU) and hospital. Results From a total of 1′543 patients, 920 were treated with ITMA and 623 with IVA. No adverse event consequent to the spinal puncture was reported. Propensity score matching created 557 balanced pairs. The occurrence of PPCs in patients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 0.6; 95% CI, 0.40–0.89; p = 0.012). Fewer patients with ITMA had a prolonged stay in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 25.5% vs. 31.8%. p = 0.024). In-hospital mortality and cardiovascular complications did not differ significantly between the two groups. Conclusion In this study involving cardiac surgical patients, ITMA was safely applied and was associated with fewer PPCs. Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0398-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, -1211, Geneva, CH, Switzerland
| | - Tornike Sologashvili
- Division of Cardiovascular Surgery, University Hospital of Geneva, rue Gabrielle-Perret Gentil, Geneva, 1211, Switzerland
| | | | - Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, -1211, Geneva, CH, Switzerland.
| |
Collapse
|
21
|
Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol 2017; 29:191-210. [DOI: 10.1097/ana.0000000000000407] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
22
|
|
23
|
Porizka M, Koudelkova K, Kopecky P, Porizkova H, Dohnalova A, Kunstyr J. High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study. SPRINGERPLUS 2016; 5:799. [PMID: 27390640 PMCID: PMC4916068 DOI: 10.1186/s40064-016-2541-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/08/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Thoracic epidural anesthesia (TEA) has been proposed to improve and facilitate early postoperative outcome in cardiac surgery. The aim of our study was to analyze early postoperative outcome data of patients undergoing cardiac surgery under general anesthesia (GA) with comparison to patients receiving combined TEA and GA. METHODS Medical records data from 288 patients who underwent elective on-pump cardiac surgery were retrieved and analyzed. Patients were divided into two study groups according to the type of anesthesia used: GA group (n = 141) and TEA group (n = 147). Early postoperative outcome data including quality of analgesia and major organ outcome parameters were compared between the study groups. RESULTS There was no major difference in early postoperative outcome data between the study groups, except for shorter time to extubation (6.0 ± 10.0 vs. 6.9 ± 8.8 h, respectively, P < 0.05) and hospital stay (10.7 ± 5.9 vs. 12.9 ± 8.8 days, respectively, P < 0.05) in TEA group compared to GA group. Also TEA group as compared to GA group had lower pain numeric rating scale scores (1 ± 1.1 vs. 1.4 ± 1.5 at 24 h, respectively, P < 0.05) and morphine requirements during the first 24 h after surgery (148.2 vs. 193 ± 85.4 μg/kg, respectively, P < 0.05). CONCLUSION Both anesthetic methods were equivalent in most postoperative outcome measures. Thoracic epidural analgesia provided superior pain relief, shorter time to extubation and earlier hospital discharge.
Collapse
Affiliation(s)
- Michal Porizka
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Katerina Koudelkova
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Petr Kopecky
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Hana Porizkova
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Alena Dohnalova
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00 Czech Republic
| | - Jan Kunstyr
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| |
Collapse
|
24
|
New Fast-Track Concepts in Thoracic Surgery: Anesthetic Implications. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
25
|
Çeliksular MC, Saraçoğlu A, Yentür E. The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia. Turk J Anaesthesiol Reanim 2016; 44:117-23. [PMID: 27366573 DOI: 10.5152/tjar.2016.65265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 02/11/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The effects of oral carbohydrate solutions, ingested 2 h prior to operation, on stress response were studied in patients undergoing general or epidural anaesthesia. METHODS The study was performed on 80 ASA I-II adult patients undergoing elective total hip replacement, which were randomized to four groups (n=20). Group G patients undergoing general anaesthesia fasted for 8 h preoperatively; Group GN patients undergoing general anaesthesia drank oral carbohydrate solutions preoperatively; Group E patients undergoing epidural anaesthesia fasted for 8 h and Group EN patients undergoing epidural anaesthesia drank oral carbohydrate solutions preoperatively. Groups GN and EN drank 800 mL of 12.5% oral carbohydrate solution at 24:00 preoperatively and 400 mL 2 h before the operation. Blood samples were taken for measurements of glucose, insulin, cortisol and IL-6 levels. RESULTS The effect of preoperative oral carbohydrate ingestion on blood glucose levels was not significant. Insulin levels 24 h prior to surgery were similar; however, insulin levels measured just before surgery were 2-3 times higher in groups GN and EN than in groups G and E. Insulin levels at the 24(th) postoperative hour in epidural groups were increased compared to those at basal levels, although general anaesthesia groups showed a decrease. From these measurements, only the change in Group EN was statistically significant (p<0.05). Plasma cortisol levels at the 2(nd) peroperative hour were higher in epidural groups than in general anaesthesia groups. Both anaesthesia techniques did not have an effect on IL-6 levels. CONCLUSION We concluded that epidural anaesthesia suppressed stress response, although preoperative oral carbohydrate nutrition did not reveal a significant effect on surgical stress response.
Collapse
Affiliation(s)
- M Cem Çeliksular
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ayten Saraçoğlu
- Department of Anaesthesiology Aad Reanimation, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ercüment Yentür
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| |
Collapse
|
26
|
Existe algum benefício em associar a anestesia neuroaxial à anestesia geral para revascularização miocárdica? Braz J Anesthesiol 2016. [DOI: 10.1016/j.bjan.2013.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
27
|
Landoni G, Isella F, Greco M, Zangrillo A, Royse CF. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth 2015; 115:25-32. [PMID: 26089444 DOI: 10.1093/bja/aev201] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Epidurals provide excellent analgesia for cardiac surgery and may reduce complications. However, their use has been tempered because of concern of the rare, but serious complication of epidural haematoma. The aim of this meta-analysis was to assess the effect of epidural on survival and the risk estimate of epidural haematoma. METHODS A systematic review of the literature (Pubmed, Embase, Scopus and the Cochrane Register) and a meta-analysis of the available randomized and case-matched studies were performed to estimate the effect on survival. An international, directed and viral anonymous survey was performed to identify the incidence of haematomas with a corresponding estimate of the number of epidurals performed. RESULTS Of 66 randomized and case-matched studies, 57 trials including 6383 patients reported the incidence of all-cause mortality at the longest follow up available, with a significant reduction with epidurals (59/3123 [1.9%] vs 108/3260 [3.3%] in the control arm, RR 0.65 [95% CI 0.48-0.86], P=0.003, NNT=70). No epidural haematoma was reported in these 66 trials (3320 epidurals). All other literature revealed nine haematomas in 13,100 patients. Through the anonymous, web-based, viral, international survey, we identified 16 further, non-published, epidural haematomas from 72,400 positioned epidurals. Therefore, a total of 25 haematomas have been identified from an estimate of 88,820 positioned epidurals, producing an estimated risk of 1:3552 (95% CI 1:2552-1:5841). CONCLUSIONS The use of epidural analgesia in cardiac surgery is associated with a reduction in mortality (NNT=70), and with an estimated risk of epidural haematoma of 1:3552.
Collapse
Affiliation(s)
- G Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute Vita-Salute San Raffaele University, Via Olgettina 60, Milan 20132, Italy
| | - F Isella
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - M Greco
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - A Zangrillo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute Vita-Salute San Raffaele University, Via Olgettina 60, Milan 20132, Italy
| | - C F Royse
- Anaesthesia and Pain Management Unit, The Royal Melbourne Hospital Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Level 6 Clinical Medical Research Building, Melbourne, VIC 3050, Australia
| |
Collapse
|
28
|
Neuburger PJ, Ngai JY, Chacon MM, Luria B, Manrique-Espinel AM, Kline RP, Grossi EA, Loulmet DF. A Prospective Randomized Study of Paravertebral Blockade in Patients Undergoing Robotic Mitral Valve Repair. J Cardiothorac Vasc Anesth 2015; 29:930-6. [DOI: 10.1053/j.jvca.2014.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Indexed: 11/11/2022]
|
29
|
|
30
|
Does high thoracic epidural analgesia with levobupivacaine preserve myocardium? A prospective randomized study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:658678. [PMID: 25918718 PMCID: PMC4395980 DOI: 10.1155/2015/658678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 01/14/2023]
Abstract
Background. Our study aimed to compare HTEA and intravenous patient-controlled analgesia (PCA) in patients undergoing coronary bypass graft surgery (CABG), based on haemodynamic parameters and myocardial functions. Materials and Methods. The study included 34 patients that were scheduled for elective CABG, who were randomly divided into 2 groups. Anesthesia was induced and maintained with total intravenous anesthesia in both groups while intravenous PCA with morphine was administered in Group 1 and infusion of levobupivacaine was administered from the beginning of the anesthesia in Group 2 by thoracic epidural catheter. Blood samples were obtained presurgically, at 6 and 24 hours after surgery for troponin I, creatinine kinase-MB (CK-MB), total antioxidant capacity, and malondialdehyde. Postoperative pain was evaluated every 4 hours until 24 hours via VAS. Results. There were significant differences in troponin I or CK-MB values between the groups at postsurgery 6 h and 24 h. Heart rate and mean arterial pressure in Group 1 were significantly higher than in Group 2 at all measurements. Cardiac index in Group 2 was significantly higher than in Group 1 at all measurements. Conclusion. Patients that underwent CABG and received HTEA had better myocardial function and perioperative haemodynamic parameters than those who did not receive HTEA.
Collapse
|
31
|
Barbosa FT, de Sousa Rodrigues CF, Castro AA, da Cunha RM, Barbosa TRBW. Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery? Braz J Anesthesiol 2015; 66:304-9. [PMID: 27108829 DOI: 10.1016/j.bjane.2013.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/16/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT The search was performed in Pubmed (January 1966 to December 2012), Embase (1974 to December 2012), The Cochrane Library (volume 10, 2012) and Lilacs (1982 to December 2012) databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. CONCLUSIONS The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.
Collapse
|
32
|
Does Paravertebral Blockade Facilitate Immediate Extubation after Totally Endoscopic Robotic Mitral Valve Repair Surgery? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:96-100. [DOI: 10.1097/imi.0000000000000134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective Immediate extubation of select patients in the operating room after cardiac surgery has been shown to be safe and may result in improved hemodynamics and decreased cost perioperatively. The aim of this study was to evaluate whether the addition of paravertebral blockade (PVB) to general anesthesia facilitates extubation in the operating room in patients undergoing totally endoscopic robotic mitral valve repair (TERMR). Methods A review of 65 consecutive patients who underwent TERMR between January 2012 and June 2013 at a single institution was conducted. Patients were divided into two groups, one group that received PVB and general anesthesia and a second group that received general anesthesia alone. The data analyzed included quantities of anesthetic administered during surgery and the location of extubation after surgery. Results A total of 34 patients received PVB and general anesthesia, whereas 31 received general anesthesia alone. The two groups had similar demographic and surgical data. Patients in the PVB and general anesthesia group were more likely to be extubated in the operating room (67.6%, n = 23 vs 41.9%, n = 13, P = 0.048) and required less intraoperative fentanyl (3.41 μg/kg vs 4.90 μg/kg, P = 0.006). There were no adverse perioperative events in either group related to PVB or extubation. Conclusions The addition of PVB to general anesthesia for perioperative pain control facilitated extubation in the operating room in patients undergoing TERMR. Paravertebral blockade allowed for lower intraoperative fentanyl dosing, which may account for the increased incidence of immediate extubation. A detailed prospective study is warranted.
Collapse
|
33
|
Neuburger PJ, Chacon MM, Luria BJ, Manrique-Espinel AM, Ngai JY, Grossi EA, Loulmet DF. Does Paravertebral Blockade Facilitate Immediate Extubation after Totally Endoscopic Robotic Mitral Valve Repair Surgery? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Peter J. Neuburger
- Departments of Anesthesiology, NYU Langone Medical Center, New York, NY USA
| | - M. Megan Chacon
- Departments of Anesthesiology, NYU Langone Medical Center, New York, NY USA
| | - Brent J. Luria
- Departments of Anesthesiology, NYU Langone Medical Center, New York, NY USA
| | | | - Jennie Y. Ngai
- Departments of Anesthesiology, NYU Langone Medical Center, New York, NY USA
| | - Eugene A. Grossi
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
| | - Didier F. Loulmet
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
| |
Collapse
|
34
|
Esper SA, Bottiger BA, Ginsberg B, Del Rio JM, Glower DD, Gaca JG, Stafford-Smith M, Neuburger PJ, Chaney MA. CASE 8--2015. Paravertebral Catheter-Based Strategy for Primary Analgesia After Minimally Invasive Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:1071-80. [PMID: 26070694 DOI: 10.1053/j.jvca.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen A Esper
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Brandi A Bottiger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Brian Ginsberg
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - J Mauricio Del Rio
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Donald D Glower
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jeffrey G Gaca
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Peter J Neuburger
- Department of Anesthesiology, New York University Medical Center, New York, NY
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| |
Collapse
|
35
|
Ferreira CGDR, Tenório SB. Clonidina subaracnóidea e resposta ao trauma em cirurgias cardíacas com circulação extracorpórea. Braz J Anesthesiol 2014; 64:395-9. [DOI: 10.1016/j.bjan.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 04/09/2013] [Indexed: 10/25/2022] Open
|
36
|
Ziyaeifard M, Azarfarin R, Golzari SE. A Review of Current Analgesic Techniques in Cardiac Surgery. Is Epidural Worth it? J Cardiovasc Thorac Res 2014; 6:133-40. [PMID: 25320659 PMCID: PMC4195962 DOI: 10.15171/jcvtr.2014.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/06/2014] [Indexed: 11/20/2022] Open
Abstract
In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers.
Collapse
Affiliation(s)
| | - Rasoul Azarfarin
- Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran
| | - Samad Ej Golzari
- Department of Anesthesiology and Intensive Care, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
37
|
Abstract
High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative recovery for the thoracic surgery patient. In the modern hospital setting with day of admission surgery, the logistics of insertion of the epidural catheter has become increasingly difficult. The greatest limitation to its use might be the believed increased risk of epidural hematoma associated with anticoagulation during cardiopulmonary bypass. The aim of this review is to give an overview of complications and effect on outcomes with focus on cardiac performance and postoperative glycemic control and kidney function. Patients with epidurals may have improved postoperative pulmonary function and shorter ventilation time, while impact on length of stay in the intensive care unit and hospital is not as evident. HTEA is effective in pain management, attenuates perioperative stress and seems to improve postoperative blood glucose control. Whether HTEA improves recovery and facilitates fast-track is still to be confirmed. With regard to serious postoperative complications, there is evidence of reduction in supraventricular arrhythmias and lower frequency of postoperative acute kidney injury and dialysis. There are some indications of lower short term mortality and frequency of postoperative myocardial infarctions, but only as a combined outcome. The present short-term mortality of 1% to 2% should be compared with the most pessimistic frequency of epidural hematoma being 1 in 4600 patients.
Collapse
|
38
|
Combined epicardial and transvenous placement of an implantable cardioverter defibrillator (ICD) lead without a median sternotomy in an 8-year-old child. Pediatr Cardiol 2014; 34:1996-7. [PMID: 23052676 DOI: 10.1007/s00246-012-0544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
An alternative to median sternotomy for epicardial placement of an implantable cardioverter defibrillator (ICD) lead in a child with hypertrophic cardiomyopathy is described. Implantation of an ICD lead via the tricuspid valve was avoided by the use of an epicardial pacing lead and a transvenous defibrillator lead placed in the vena brachiocephalica. The abdominal, subcostal pocket incision was used for an anterolateral minithoracotomy to implant the epicardial pacing lead.
Collapse
|
39
|
|
40
|
Nigro Neto C, do Amaral JLG, Arnoni R, Tardelli MA, Landoni G. Intrathecal sufentanil for coronary artery bypass grafting. Braz J Anesthesiol 2014; 64:73-8. [PMID: 24794447 DOI: 10.1016/j.bjane.2012.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 12/11/2012] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Cardiac surgery patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. OBJECTIVE Evaluate the effect of adding intrathecal sufentanil to general anesthesia on hemodynamics. DESIGN Prospective, randomized, not blinded study, after approval by local ethics in Research Committee. SETTING Monocentric study performed at Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil. PATIENTS 40 consenting patients undergoing elective coronary artery bypass, both genders. EXCLUSION CRITERIA Chronic kidney disease; emergency procedures; reoperations; contraindication to spinal block; left ventricular ejection fraction less than 40%; body mass index above 32kg/m(2) and use of nitroglycerin. INTERVENTIONS Patients were randomly assigned to receive intrathecal sufentanil 1μg/kg or not. Anesthesia induced and maintained with sevoflurane and continuous infusion of remifentanil. MAIN OUTCOME MEASURES Hemodynamic variables, blood levels of cardiac troponin I, B-type natriuretic peptide, interleukin-6 and tumor necrosis factor alfa during and after surgery. RESULTS Patients in sufentanil group required less inotropic support with dopamine when compared to control group (9.5% vs 58%, p=0.001) and less increases in remifentanil doses (62% vs 100%, p=0.004). Hemodynamic data at eight different time points and biochemical data showed no differences between groups. CONCLUSIONS Patients receiving intrathecal sufentanil have more hemodynamical stability, as suggested by the reduced inotropic support and fewer adjustments in intravenous opioid doses.
Collapse
Affiliation(s)
- Caetano Nigro Neto
- Instituto de Cardiologia Dante Pazzanese, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | - Renato Arnoni
- Instituto de Cardiologia Dante Pazzanese, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | |
Collapse
|
41
|
Neto CN, Amaral JLGD, Arnoni R, Tardelli MA, Landoni G. Sufentanil intratecal para revascularização do miocárdio. Braz J Anesthesiol 2014. [DOI: 10.1016/j.bjan.2012.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
42
|
Pain and inflammatory response following off-pump coronary artery bypass grafting. Curr Opin Anaesthesiol 2014; 27:106-15. [DOI: 10.1097/aco.0000000000000036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Monaco F, Biselli C, Landoni G, De Luca M, Lembo R, Covello RD, Zangrillo A. Thoracic epidural anesthesia improves early outcome in patients undergoing cardiac surgery for mitral regurgitation: a propensity-matched study. J Cardiothorac Vasc Anesth 2013; 27:445-50. [PMID: 23672861 DOI: 10.1053/j.jvca.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There are no large studies that investigate the effect of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) in patients undergoing valvular surgery. The authors hypothesized that TEA might improve clinically relevant endpoints in patients with primary mitral regurgitation. DESIGN Propensity-matched study. SETTING Cardiac surgery. PARTICIPANTS Patients scheduled for mitral valve repair or replacement were studied. INTERVENTIONS A propensity model was constructed to match 33 patients receiving TEA combined with GA with 33 patients receiving standard GA alone. MEASUREMENTS AND MAIN RESULTS Overall, the TEA group suffered fewer adverse events than the GA group: 10 (30%) v 23 (10%) with p = 0.002. In particular, the TEA group had a lower incidence of pulmonary events, 6 (18%) v 15 (45%) with p = 0.02, and of cardiac events, 8 (24%) v 16 (49%) with p = 0.04. Median (interquartile) time on mechanical ventilation was reduced in the TEA group, 11 (9-15) v 17 (12-36) with p = 0.007. CONCLUSIONS This propensity-matched study suggested that TEA might be advantageous in patients undergoing surgery for mitral regurgitation.
Collapse
Affiliation(s)
- Fabrizio Monaco
- Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Regional anesthesia has become invaluable for the treatment of pain during and after a wide range of surgical procedures. However, its benefits in the nonsurgical setting have been less well studied. Regional anesthesia is an appealing modality for critically ill patients, providing focused and sustained pain control with beneficial systemic effect profiles. Indications for regional anesthesia in this patient group are not limited to surgical and postsurgical analgesia but expand to the management of trauma-related issues, medical conditions, and painful procedures at the bedside. Patients in the critical care unit present special challenges to the regional anesthesiologist, including coagulopathies, infections, immunocompromised states, sedation- and ventilation-associated problems, and factors potentially increasing the risk for systemic toxicity. This review is intended to evaluate the role of regional anesthesia in critically ill patients, to discuss potential benefits, and to provide a summary of the published evidence on the subject.
Collapse
|
45
|
Svircevic V, Passier MM, Nierich AP, van Dijk D, Kalkman CJ, van der Heijden GJ. Epidural analgesia for cardiac surgery. Cochrane Database Syst Rev 2013:CD006715. [PMID: 23740694 DOI: 10.1002/14651858.cd006715.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A combination of general anaesthesia (GA) with thoracic epidural analgesia (TEA) may have a beneficial effect on clinical outcomes by reducing the risk of perioperative complications after cardiac surgery. OBJECTIVES The objective of this review was to determine the impact of perioperative epidural analgesia in cardiac surgery on perioperative mortality and cardiac, pulmonary or neurological morbidity. We performed a meta-analysis to compare the risk of adverse events and mortality in patients undergoing cardiac surgery under general anaesthesia with and without epidural analgesia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12) in The Cochrane Library; MEDLINE (PubMed) (1966 to November 2012); EMBASE (1989 to November 2012); CINHAL (1982 to November 2012) and the Science Citation Index (1988 to November 2012). SELECTION CRITERIA We included randomized controlled trials comparing outcomes in adult patients undergoing cardiac surgery with either GA alone or GA in combination with TEA. DATA COLLECTION AND ANALYSIS All publications found during the search were manually and independently reviewed by the two authors. We identified 5035 titles, of which 4990 studies did not satisfy the selection criteria or were duplicate publications, that were retrieved from the five different databases. We performed a full review on 45 studies, of which 31 publications met all inclusion criteria. These 31 publications reported on a total of 3047 patients, 1578 patients with GA and 1469 patients with GA plus TEA. MAIN RESULTS Through our search (November 2012) we have identified 5035 titles, of which 31 publications met our inclusion criteria and reported on a total of 3047 patients. Compared with GA alone, the pooled risk ratio (RR) for patients receiving GA with TEA showed an odds ratio (OR) of 0.84 (95% CI 0.33 to 2.13, 31 studies) for mortality; 0.76 (95% CI 0.49 to 1.19, 17 studies) for myocardial infarction; and 0.50 (95% CI 0.21 to 1.18, 10 studies) for stroke. The relative risks (RR) for respiratory complications and supraventricular arrhythmias were 0.68 (95% CI 0.54 to 0.86, 14 studies) and 0.65 (95% CI 0.50 to 0.86, 15 studies) respectively. AUTHORS' CONCLUSIONS This meta-analysis of studies, identified to 2010, showed that the use of TEA in patients undergoing coronary artery bypass graft surgery may reduce the risk of postoperative supraventricular arrhythmias and respiratory complications. There were no effects of TEA with GA on the risk of mortality, myocardial infarction or neurological complications compared with GA alone.
Collapse
Affiliation(s)
- Vesna Svircevic
- Department of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
| | | | | | | | | | | |
Collapse
|
46
|
Pompeo E, Dauri M. Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis? J Thorac Cardiovasc Surg 2013; 146:495-7.e1. [PMID: 23601750 DOI: 10.1016/j.jtcvs.2013.03.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/19/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
| | | |
Collapse
|
47
|
Haanschoten MC, van Straten AHM, ter Woorst JF, Stepaniak PS, van der Meer AD, van Zundert AAJ, Soliman Hamad MA. Fast-track practice in cardiac surgery: results and predictors of outcome. Interact Cardiovasc Thorac Surg 2012; 15:989-94. [PMID: 22951954 DOI: 10.1093/icvts/ivs393] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Various studies have shown different parameters as independent risk factors in predicting the success of fast-track postoperative management in cardiac surgery. In the present study, we evaluated our 7-year experience with the fast-track protocol and investigated the preoperative predictors of successful outcome. METHODS Between 2004 and 2010, 5367 consecutive patients undergoing cardiac surgery were preoperatively selected for postoperative admission in the postanaesthesia care unit (PACU) and were included in this study. These patients were then transferred to the ordinary ward on the same day of the operation. The primary end-point of the study was the success of the PACU protocol, defined as discharge to the ward on the same day, no further admission to the intensive care unit and no operative mortality. Logistic regression analysis was performed to detect the independent risk factors for failure of the PACU pathway. RESULTS Of 11,895 patients undergoing cardiac surgery, 5367 (45.2%) were postoperatively admitted to the PACU. The protocol was successful in 4510 patients (84.0%). Using the multivariate logistic regression analysis, older age and left ventricular dysfunction were found to be independent risk factors for failure of the PACU protocol [odds ratio of 0.98/year (0.97-0.98) and 0.31 (0.14-0.70), respectively]. CONCLUSIONS Our fast-track management, called the PACU protocol, is efficient and safe for the postoperative management of selected patients undergoing cardiac surgery. Age and left ventricular dysfunction are significant preoperative predictors of failure of this protocol.
Collapse
Affiliation(s)
- Marco C Haanschoten
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
48
|
Carmona P, Llagunes J, Casanova I, Mateo E, Cánovas S, Martín E, Marqués JI, Peña JJ, de Andrés J. [Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy]. ACTA ACUST UNITED AC 2012; 59:476-82. [PMID: 22657350 DOI: 10.1016/j.redar.2012.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/11/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy. MATERIAL AND METHODS A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques. RESULTS A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed. DISCUSSION PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.
Collapse
Affiliation(s)
- P Carmona
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Consorcio Hospital General Universitario de Valencia, España.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Intraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery. Reg Anesth Pain Med 2012; 36:271-7. [PMID: 21519312 DOI: 10.1097/aap.0b013e318217aada] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Regional anesthesia has been shown to blunt the response to surgical stress and decrease the use of volatile anesthetics and the consumption of opioids, which may reduce immune compromise and potentially delay tumor recurrence. The goal of this study was to find a possible association between intraoperative regional anesthesia and decreased cancer recurrence. METHODS Patients who underwent surgery for ovarian cancer between January 1, 2000, and October 1, 2006, were included. Subjects who had optimal surgical debulking (<1.0 cm of remaining tumor) were evaluated for time to tumor recurrence (carcinoantigen 125 >21 U/mL or computed tomography evidence of disease progression) and/or death. RESULTS One hundred eighty-two patients were evaluated; 127 did not receive epidural anesthesia/analgesia. Among the 55 who had epidural catheters placed, 26 were used intraoperatively and postoperatively; 29 were used only postoperatively. Cancer recurrence was documented in 121 patients. The median (interquartile range) time to recurrence was 40 (25-52) months. The intraoperative use epidural group had a mean (95% confidence interval) time to recurrence of 73 (56-91) months, which was longer than either the epidural postoperative group 33 (21-45) months (P = 0.002) or the no-epidural group 38 (30-47) months (P = 0.001). The postoperative-only and no-epidural groups were not different (P = 0.92). Intraoperative epidural significantly reduced (hazard ratio, 0.37 [95% confidence interval, 0.19-0.73]) tumor recurrence risk. CONCLUSIONS Intraoperative use of epidural anesthesia was associated with an increased time to tumor recurrence after surgery in ovarian cancer patients. This may be a result of preservation of the immune system function.
Collapse
|
50
|
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
|