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

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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.

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

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