Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Comparative assessment of the effectiveness and safety of choracic epidural and inhalational anesthesia of sevofluranes in coronary arto bypass granging using the OPCAB method

Authors: Khinchagov D.Ya., Rybka M.M., Mumladze K.V., Golubev E.P., Yudin G.V., Aydashev Yu.Yu.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/ 1814-6910-2023-20-2-173-180

UDC: 616.831.959-089.5:616.12-089.86

Link: Clinical Physiology of Blood Circulaiton. 2023; 3 (20): 173-180

Quote as: Khinchagov D.Ya., Rybka M.M., Mumladze K.V., Golubev E.P., Yudin G.V., Aydashev Yu.Yu. Comparative assessment of the effectiveness and safety of choracic epidural and inhalational anesthesia of sevofluranes in coronary arto bypass granging using the OPCAB method. Clinical Physiology of Circulation. 2023; 20 (2): 173–80 (in Russ.). DOI: 10.24022/ 1814-6910-2023-20-2-173-180

Received / Accepted:  19.05.2023 / 14.06.2023

Download
Full text:  

Abstract

Objective. To compare the effectiveness and safety of thoracic epidural anesthesia and inhalational anesthesia for OPCAB (off-pump coronary artery bypass) operations.

Material and method. A single-center prospective randomized study, which included 60 patients with OPCAB operations operated between 2017 and 2018. Using the envelope method, they were randomized into 2 groups depending on the tactics of anesthesia: 1st group with thoracic epidural anesthesia (ТEA) – 29 patients, 2nd group with inhalation anesthesia based on sevoflurane (IA) – 31 patients. The acid-base state and gas composition of arterial and mixed venous blood, the concentration of hemoglobin, glucose and lactate, biochemical parameters, duration of mechanical ventilation, cardiotonic support and intraoperative balance were analyzed. To assess the clinical course of the intraoperative period, a comparative analysis of blood pressure and heart rate indicators was performed at the stage of skin incision, during bypass of the arteries of the anterior wall, arteries of the lateral wall, arteries of the posterior wall and at the end of the operation. A comparison was made of central hemodynamic parameters before the main stage and at the skin suture stage. At the same stages, the following indicators were calculated: index of oxygen delivery (IDaO2), index of oxygen consumption (IVO2) and oxygen extraction coefficient (О2ER).

Results. According to the results of our study, in both groups, stability indicators (BP, HR) of hemodynamics were maintained at all stages of the operation. At the end of the operation, when comparing the parameters of the peripheral vascular resistance between groups (dyn/s/cm5), there was a statistically insignificant difference: ТEA – 1220.2 ± 222.7, AI – 1115.9 ± 263.9. At the end of the operation, the groups did not differ in vasopressor support – doses of norepinephrine, despite the use of inhalational anesthetics. The concentrations of blood glucose and lactate (mmol/l) at the time of skin suture were within acceptable values: lactate – ТEA – 1.1 ± 0.5, AI – 1.3 ± 0.3; glucose – ТEA – 7.6 ± 1.8, IA – 9.4 ± 1.7. When comparing between groups at the end of the operation, no statistically significant differences in IdaO2, IVO2 and О2ER were found. When comparing between groups, no statistically significant difference in the duration of mechanical ventilation (hours) was obtained: ТEA – 6.0 ± 2.3, AI – 5.1 ± 2.2.

Conclusion. Thoracic epidural anesthesia and inhalation anesthesia make it possible to maintain hemodynamic stability at all stages of the operation, provide reliable protection against surgical stress and allow early activation of the patient, increasing the efficiency and safety of these operations.

References

  1. Hemmerling T.M., Romano G., Terrasini N., Noiseux N. Anesthesia for off-pump coronary artery bypass surgery. Ann. Card. Anaesth. 2013; 16 (1): 28–39. DOI: 10.4103/0971-9784.105367
  2. Mehta Y., Arora D., Vats M. Epidural analgesia in high risk cardiac surgical patients. HSR Proc. Intensive Care Cardiovasc. Anesth. 2012; 4 (1): 11–14.
  3. Zhang S., Wu X., Guo H., Ma L. Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials. Eur. J. Med. Res. 2015; 20 (1): 25. DOI: 10.1186/s40001-015-0091-y.
  4. Brioni J.D., Varughese S., Ahmed R., Bein B. A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics. J. Anesth. 2017; 31 (5): 764–78. DOI: 10.1007/s00540-017-2375-6
  5. Khan K.S., Hayes I., Buggy D.J. Pharmacology of anaesthetic agents II: inhalation anaesthetic agents. Continuing Education in Anaesthesia, Critical Care & Pain. 2014; 14 (3): 106–111. DOI: 10.1093/bjaceaccp/mkt038
  6. Verma I., Verma Ch., Sharma R., Dhaked S. Comparative study of sevoflurane versus desflurane on hemodynamics in off pump coronary artery bypass grafting. Anesth. Crit. Care. 2020; 2 (2): 25–38. DOI: 10.26502/acc.013
  7. Wink J., Veering B.T., Aarts L.P.H.J., Wouters P.F. Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function. Anesthesiology. 2019; 130 (3): 472–91. DOI: 10.1097/ALN.0000000000002558
  8. Moodley S. OPCAB The secrets of the beating heart. Medicine; 2015. Available at: https://www.semanticscholar.org (accessed June 14, 2023). 9. Toledano R.D., Van De Velde M. Epidural anesthesia and analgesia. In: Hadzic A. Regional anesthesia and acute pain management, 2nd ed. McGraw Hill/Medical; 2017: 380–445.
  9. Greisen J., Nielsen D.V., Sloth E., Jakobsen C.J. High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients. Acta Anaesthesiol. Scand. 2013; 57 (2): 171–7. DOI: 10.1111/j.1399-6576.2012.02731.x.
  10. American Diabetes Association 15. Diabetes care in the hospital: standards of medical care in diabetes – 2020. Diabetes Care. 2020; 43: 193–202. DOI: 10.2337/dc20- S015
  11. Kim S., Park J., Kim H., Yang K., Choi J.H., Kim K. et al. Intraoperative hyperglycemia may be associated with an increased risk of myocardial injury after non-cardiac surgery in diabetic patients. J. Clin. Med. 2021; 10 (22): 5219. DOI: 10.3390/jcm10225219
  12. Duncan A.E. Hyperglycemia and perioperative glucose management. Curr. Pharm. Des. 2012; 18 (38): 6195–203. DOI: 10.2174/138161212803832236
  13. Garcia-Alvarez M., Marik P., Bellomo R. Stress hyperlactataemia: present understanding and controversy. Lancet Diabetes Endocrinol. 2014; 2 (4): 339–47. DOI: 10.1016/S2213-8587(13)70154-2
  14. Jakobsen C.J. High thoracic epidural in cardiac anesthesia: a review. Semin. Cardiothorac. Vasc. Anesth. 2015; 19 (1): 38–48. DOI: 10.1177/1089253214548764 16.
  15. Myles P.S., McIlroy D. Fast-track cardiac anesthesia: choice of anesthetic agents and techniques. Semin. Cardiothorac. Vasc. Anesth. 2005; 9 (1): 5–16. DOI: 10.1177/108925320500900102
  16. Ranucci M. Anaesthesia and cardiopulmonary bypass aspects of fast track. Eur. Heart J. Supplements. 2017; 19: 15–7. DOI: 10.1093/eurheartj/suw054
  17. Zientara A., Mariotti S., Matter-Ensner S., Seifert B., Graves K., Dzemali O., Genoni M. Fast-track management in off-pump coronary artery bypass grafting: dexmedetomidine provides rapid extubation and effective pain modulation. Thorac. Cardiovasc. Surg. 2019; 67 (6): 450–7. DOI: 10.1055/s-0038-1668602

About Authors

  • Dzhumber Ya. Khinchagov, Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology and Intensive Care Unit; ORCID
  • Koba V. Mumladze, Anesthesiologist-Intensivist; ORCID
  • Evgeniy P. Golubev, Cand. Med. Sci., Senior Research Associate, Cardiovascular Surgeon; ORCID
  • Gennadiy V. Yudin, Cand. Med. Sci., Head of the Department of Resuscitation and Intensive Care; ORCID
  • Yuris Yu. Aydashev, Anesthesiologist-Intensivist; ORCID

 If you found mistakes, select text and press Alt+A