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


Intraoperative hemodynamics in left ventricular geometric reconstruction combined with coronary artery bypass grafting using high thoracic epidural anesthesia as a basic component of general anesthesia

Authors: Zatevakhina M.V., Farzutdinov A.F., Rakhimov A.A., Lobacheva G.V., Alshibaya M.M.

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Link: Clinical Physiology of Blood Circulaiton. 2014; (): -

Quote as: Zatevakhina M.V., Farzutdinov A.F., Rakhimov A.A., Lobacheva G.V., Alshibaya M.M. Intraoperative hemodynamics in left ventricular geometric re- construction combined with coronary artery bypass grafting using high thoracic epidural anesthesia as a basic component of general anesthesia. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2014; 3: 23-33.

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Abstract

Objective of the research – to examine the intraoperative hemodynamics in left ventricular geometric reconstruction in conjunction with coronary artery bypass grafting (CABG) using high thoracic epidural anesthesia (HTEA) as the main component of general anesthesia (GA).
Material and methods. In the Department of surgical ischemic heart disease (IHD) treatment in more than 70 patients underwent a left ventricular geometric reconstruction (Dor procedure) and CABG in conditions of extracorporeal circula- tion (EC) and pharmaco-cold cardioplegia. The study included 53 patients: 41 men and 12 women. All examined patients were divided into 2 groups depending on the type of anesthesia. The main study group contained 30 (56.6%) patients, who received HTEA (GA + HTEA) as the principal component of anesthesia, and the control group was composed of 23 (43.4%) patients who received a classical multicomponent general anesthesia (MGA).
Results. The inclusion of HTEA in anesthesia schemes for patients with IHD during left ventricular geometric reconstruc- tion (Dor procedure) in combination with CABG in conditions of artificial blood circulation has increased the efficiency of the ventricles and optimized intraoperative hemodynamics in general. At all stages of the perioperative period hemody- namic efficiency in the main study group was significantly higher and more stable than in the control group, caused by an increased heart performance. In the control group a progressive instability of hemodynamics was observed, requiring more powerful medicinal and mechanical (intraaortical ballon contrapulsation) support. A statistically reliable difference in the time of anesthesia recovery, recovery of autonomous respiration and extubation, as well as the patients' stay duration in the resuscitation department has been observed in favour of patients in the main study group.
Conclusion. During the intraoperative period in core group established an adequate central and peripheral hemodynam- ics, the absence of acute heart failure main rhythm. A tendency to reduce the pressure in pulmonary artery and its stabi- lization. Could also significantly reduce the number of hypnotic drugs, narcotic analgesics and neuromuscular blocking agents that affect the speed of recovery of consciousness, duration after the operating artificial pulmonary ventilation and the total time of stay in the intensive care department.

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