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Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial
INTRODUCTION: Most recent studies tend to confirm the beneficial effect of thoracic epidural analgesia (TEA) in cardiac surgery. AIM: To assess whether intensive care unit TEA has an influence on the perioperative course following low-risk coronary artery surgery. MATERIAL AND METHODS: This prospect...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066681/ https://www.ncbi.nlm.nih.gov/pubmed/30069186 http://dx.doi.org/10.5114/kitp.2018.76471 |
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author | Obersztyn, Maciej Trejnowska, Ewa Nadziakiewicz, Paweł Knapik, Piotr |
author_facet | Obersztyn, Maciej Trejnowska, Ewa Nadziakiewicz, Paweł Knapik, Piotr |
author_sort | Obersztyn, Maciej |
collection | PubMed |
description | INTRODUCTION: Most recent studies tend to confirm the beneficial effect of thoracic epidural analgesia (TEA) in cardiac surgery. AIM: To assess whether intensive care unit TEA has an influence on the perioperative course following low-risk coronary artery surgery. MATERIAL AND METHODS: This prospective, randomized trial was performed in patients scheduled for low-risk coronary artery surgery. Eighty patients undergoing off-pump or on-pump coronary artery bypass surgery were prospectively randomized to receive either combined general and epidural anesthesia or general anesthesia only. Time of postoperative ventilations and intensive care unit stay was compared between the groups. For all comparisons (p < 0.05) was considered statistically significant. RESULTS: The addition of TEA to general anesthesia significantly attenuated the stress response expressed by intraoperative heart rate, systolic blood pressure and cumulative doses of opioids. Time to the return of spontaneous respiration, time to extubation and time of stay in the postoperative care unit were all shorter in the study group, with no difference in hospital stay. Patients with TEA required midazolam less frequently (12.8% vs. 53.8%, p < 0.001). The percentage of patients given morphine in the study group was lower (46.2% vs. 89.7%, p < 0.001) and the mean dose given in patients receiving morphine was also lower (9.3 ±5.3 mg vs. 18.2 ±9.1 mg, p < 0.001). CONCLUSIONS: Addition of TEA to general anesthesia shortens the return of respiratory function, duration of mechanical ventilation and ICU stay in the postoperative period after coronary artery surgery, providing comparable hemodynamic stability to general anesthesia alone. |
format | Online Article Text |
id | pubmed-6066681 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-60666812018-08-01 Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial Obersztyn, Maciej Trejnowska, Ewa Nadziakiewicz, Paweł Knapik, Piotr Kardiochir Torakochirurgia Pol Original Paper INTRODUCTION: Most recent studies tend to confirm the beneficial effect of thoracic epidural analgesia (TEA) in cardiac surgery. AIM: To assess whether intensive care unit TEA has an influence on the perioperative course following low-risk coronary artery surgery. MATERIAL AND METHODS: This prospective, randomized trial was performed in patients scheduled for low-risk coronary artery surgery. Eighty patients undergoing off-pump or on-pump coronary artery bypass surgery were prospectively randomized to receive either combined general and epidural anesthesia or general anesthesia only. Time of postoperative ventilations and intensive care unit stay was compared between the groups. For all comparisons (p < 0.05) was considered statistically significant. RESULTS: The addition of TEA to general anesthesia significantly attenuated the stress response expressed by intraoperative heart rate, systolic blood pressure and cumulative doses of opioids. Time to the return of spontaneous respiration, time to extubation and time of stay in the postoperative care unit were all shorter in the study group, with no difference in hospital stay. Patients with TEA required midazolam less frequently (12.8% vs. 53.8%, p < 0.001). The percentage of patients given morphine in the study group was lower (46.2% vs. 89.7%, p < 0.001) and the mean dose given in patients receiving morphine was also lower (9.3 ±5.3 mg vs. 18.2 ±9.1 mg, p < 0.001). CONCLUSIONS: Addition of TEA to general anesthesia shortens the return of respiratory function, duration of mechanical ventilation and ICU stay in the postoperative period after coronary artery surgery, providing comparable hemodynamic stability to general anesthesia alone. Termedia Publishing House 2018-06-25 2018-06 /pmc/articles/PMC6066681/ /pubmed/30069186 http://dx.doi.org/10.5114/kitp.2018.76471 Text en Copyright: © 2018 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska) http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original Paper Obersztyn, Maciej Trejnowska, Ewa Nadziakiewicz, Paweł Knapik, Piotr Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
title | Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
title_full | Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
title_fullStr | Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
title_full_unstemmed | Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
title_short | Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
title_sort | evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery – a prospective randomized trial |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066681/ https://www.ncbi.nlm.nih.gov/pubmed/30069186 http://dx.doi.org/10.5114/kitp.2018.76471 |
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