The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation

Objective: to evaluate the efficiency of high thoracic epidural anesthesia (EA) and analgesia during aortocoronary bypass surgery (ACBS) without extracorporeal circulation (EC). Subjects and methods. The study enrolled 93 patients who had undergone ACBS without EC. The patients were randomized to th...

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Main Authors: A. V. Yeremeyev, A. A. Smetkin, M. Yu. Kirov
Format: Article
Language:Russian
Published: Russian Academy of Medical Sciences 2010-12-01
Series:Obŝaâ Reanimatologiâ
Online Access:https://www.reanimatology.com/rmt/article/view/365
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spelling doaj-5419740780a8428083773300f2e32bf22021-07-28T21:21:52ZrusRussian Academy of Medical SciencesObŝaâ Reanimatologiâ1813-97792411-71102010-12-016610.15360/1813-9779-2010-6-45365The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal CirculationA. V. YeremeyevA. A. SmetkinM. Yu. KirovObjective: to evaluate the efficiency of high thoracic epidural anesthesia (EA) and analgesia during aortocoronary bypass surgery (ACBS) without extracorporeal circulation (EC). Subjects and methods. The study enrolled 93 patients who had undergone ACBS without EC. The patients were randomized to three groups: 1) 30 controls who had balanced endotracheal anesthesia with propofol and fentanyl and postoperative intravenous analgesia with fentanyl; 2) 30 patients who received epidural infusion with combined endotracheal and epidural (0.75% ropivacaine, 10—12 ml, and fentanyl, 2—3 ^g/kg) anesthesia and postoperative infusion of 0.2% ropivacaine and fentanyl, 2 ^g/ml, into the epidural space at a rate of 3—10 ml/hr; 3) 30 patients who had epidural infusion with autoanalgesia in which autoanalgesia with ropivacaine and fentanyl were additionally used during their epidural infusion after ACBS. Results. The less severe degrees of arterial hypertension and myocardial depression were observed in the EA groups during ACBS (p<0.05). In these groups, the mean decreases in the intraoperative consumption of propofol, fentanyl, and nitroglycerol were 15%, 50%, and 7-fold, respectively. As compared with the controls, the frequency of the use of colloids and sympathomimetics showed at the same time 2- and 3-fold increases, respectively (p<0.05). In the postoperative period, arterial oxygenation was higher during epidural infusion with autoanalgesia and the value of lactate was higher in the control group (p<0.05). Epidural infusion ensured the maximum reduction in the magnitude of pain syndrome; there was a 46% drop in the time of postoperative mechanical ventilation in the epidural autoanalgesia group (p<0.05). Conclusion. During ACBS without ES, _ epidural anesthesia and analgesia provided hemodynamic stability and optimal postoperative analgesia. After ACBS, epidural infusion with autoanalgesia improves lung function and tissue perfusion and reduces the duration of respiratory support. Key words: aortocoronary bypass surgery, hemodynamics, epidural anesthesia, analgesia.https://www.reanimatology.com/rmt/article/view/365
collection DOAJ
language Russian
format Article
sources DOAJ
author A. V. Yeremeyev
A. A. Smetkin
M. Yu. Kirov
spellingShingle A. V. Yeremeyev
A. A. Smetkin
M. Yu. Kirov
The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation
Obŝaâ Reanimatologiâ
author_facet A. V. Yeremeyev
A. A. Smetkin
M. Yu. Kirov
author_sort A. V. Yeremeyev
title The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation
title_short The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation
title_full The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation
title_fullStr The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation
title_full_unstemmed The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation
title_sort efficiency of epidural anesthesia and postoperative analgesia during myocardial revascularization without extracorporeal circulation
publisher Russian Academy of Medical Sciences
series Obŝaâ Reanimatologiâ
issn 1813-9779
2411-7110
publishDate 2010-12-01
description Objective: to evaluate the efficiency of high thoracic epidural anesthesia (EA) and analgesia during aortocoronary bypass surgery (ACBS) without extracorporeal circulation (EC). Subjects and methods. The study enrolled 93 patients who had undergone ACBS without EC. The patients were randomized to three groups: 1) 30 controls who had balanced endotracheal anesthesia with propofol and fentanyl and postoperative intravenous analgesia with fentanyl; 2) 30 patients who received epidural infusion with combined endotracheal and epidural (0.75% ropivacaine, 10—12 ml, and fentanyl, 2—3 ^g/kg) anesthesia and postoperative infusion of 0.2% ropivacaine and fentanyl, 2 ^g/ml, into the epidural space at a rate of 3—10 ml/hr; 3) 30 patients who had epidural infusion with autoanalgesia in which autoanalgesia with ropivacaine and fentanyl were additionally used during their epidural infusion after ACBS. Results. The less severe degrees of arterial hypertension and myocardial depression were observed in the EA groups during ACBS (p<0.05). In these groups, the mean decreases in the intraoperative consumption of propofol, fentanyl, and nitroglycerol were 15%, 50%, and 7-fold, respectively. As compared with the controls, the frequency of the use of colloids and sympathomimetics showed at the same time 2- and 3-fold increases, respectively (p<0.05). In the postoperative period, arterial oxygenation was higher during epidural infusion with autoanalgesia and the value of lactate was higher in the control group (p<0.05). Epidural infusion ensured the maximum reduction in the magnitude of pain syndrome; there was a 46% drop in the time of postoperative mechanical ventilation in the epidural autoanalgesia group (p<0.05). Conclusion. During ACBS without ES, _ epidural anesthesia and analgesia provided hemodynamic stability and optimal postoperative analgesia. After ACBS, epidural infusion with autoanalgesia improves lung function and tissue perfusion and reduces the duration of respiratory support. Key words: aortocoronary bypass surgery, hemodynamics, epidural anesthesia, analgesia.
url https://www.reanimatology.com/rmt/article/view/365
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