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


Особенности анестезиологического обеспечения операций на работающем сердце

Link: Clinical Physiology of Blood Circulaiton. 2005; (): -

Download
Full text:  

Abstract

Patients with coronary artery disease have a high risk of adverse cardiac outcome during and after surgery. Thoracic epidural anesthesia (TEA) aims at a more specific reversible blockade of cardiac sympathetic efferents and provides effective intra- and postoperative analgesia. In the TEA group heart rate (HR) was low (12,6%, p <0,05) compared with the group of traditional anesthesia during the construction of the anastomoses for any of the three surgical setting. Stroke index was higher (17,4%) in TEA group that specifies to more optimum work of heart at which the greatest duration of diastole is kept for improvement of a coronary blood flow. Myocardial oxygen consumption decreases due to decreased heart rate and low peripheral vascular resistance (11,8%) and pulmonary vascular resistance (26,3%) in comparison with control group. Conclusion: TEA provides better hemodynamic control and analgesia compared with traditional anesthesia.

References

1. Blomberg S., Emanuelsson H., Rickstein S. E. Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris // Anesth. Analg. - 1989. - Vol. 69. - P. 558-562.
2. Flameng W. Role of myocardial protection for coronary artery bypass grafting on the beating heart // Ann. Thorac. Surg. - 1997. - Vol. 63. - P. S18-S22.
3. Guyton R. A., Thourani V. H., Puskas J. D. et al. Perfusionassisted direct coronary artery bypass: Selective graft perfusion in off-pump cases // Ibid. - 2000. - Vol. 69. - P. 171-175.
4. Heijmen R. H., Hinchliffe P., Borst C. et al. A novel one-shot anastomotic stapler prototype for coronary bypass grafting on the beating heart: Feasibility in the pig // J. Thorac. Cardiovasc. Surg. - 1999. - Vol. 117. - P. 117-125.
5. Jansen E. W. L., Borst C., Lahpor J. R. et al. Coronary artery bypass grafting without cardiopulmonary bypass using the Octopus method: Results in the first 100 patients // Ibid. - 1998. - Vol. 116. - P. 60-67.
6. Kirno K., Friberg P., Grzegorczyk M. et al. Thoracic epidural anaesthesia during artery coronary bypass surgery: Effects on cardiac sympathetic activity, myocardial blood flow and metabolism, and central hemodynamics // Anesth. Analg. - 1994. - Vol. 79. - P. 1075-1081.
7. Kock M., Blomberg S., Emanuelsson H. et al. Thoracic epidural anaesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease // Ibid. - 1990. - Vol. 71. - P. 625-630.
8. Koh T. W., Carr-White G. S., DeSouza A. C. et al. Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: Comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass // Heart. - 1999. - Vol. 81. - P. 495-500.
9. Meifsner A., Rolf N., Van Aken H. Thoracic epidural anesthesia and the patient with heart disease: Benefits, risks, and controversies // Anesth. Analg. - 1997. - Vol. 85. - P. 517-528.
10. Menon A. K., Albes J. M. et al. Occlusion versus shunting during MIDCAB: Effects on left ventricular function and quality of anastomosis // Ann. Thorac. Surg. - 2002. - Vol. 73. - P. 1418-1423.
11. Newman M. F., Wolman R., Kanchuger M. et al. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery // Circulation. - 1996. - Vol. 94 (Suppl.). - P. 74-79.
12. Penttilд H. J., Lepojдrvi M. V. K., Kiviluoma K. T. et al. Myocardial preservation during coronary surgery with and without cardiopulmonary bypass // Ann. Thorac. Surg. - 2001. - Vol. 71. - P. 565-570.
13. Puskas J. D., Vinten-Johansen J., Muraki S., Guyton R. A. Myocardial protection for off-pump coronary artery bypass surgery // Semin. Thorac. Cardiovasc. Surg. - 2001. - Vol. 13, № 1. - P. 82-88.
14. Puskas J. D., Wright C. E., Ronson R. S. et al. Off-pump multivessel coronary bypass via sternotomy is safe and effective // Ann. Thorac. Surg. - 1998. - Vol. 66. - P. 1068-1072.
15. Royse C., Royse A. G., Soeding P. et al. Prospective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery // Ibid. - 2003. - Vol. 75. - P. 93-100.
16. Stenseth R., Bjella L., Berg E. M. et al. Thoracic epidural analgesia in aortocoronary bypass surgery II. Effects on the endocrine metabolic response // Acta Anaesth. Scandinavica. - 1994. - Vol. 38. - P. 834-839.
17. Subramanian V. Minimally invasive coronary artery bypass grafting on the beating heart // Minimally invasive cardiac surgery / Eds M. C. Oz, D. J. Goldstein. - Totowa, NJ: Humana Press, 1999. - P. 89-103.

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