Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients.
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Date
2015-07
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Abstract
Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile
anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used
as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump
coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass
grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the
stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge,
tumor necrosis factor-Alpha( TNF ά), interleukin-6 and leucocyte count. Design: A prospective randomised non
blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and
Methods/intervention: The study was approved by hospital research ethics committee and written informed
consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study
group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for
OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease,
cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin:
– 6, TNF ά, cortisol, Troponin – I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared
for both the group and venous blood samples were collected and compared just after induction, at day 2, and
day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were
noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative
complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result:
Study group showed decreased Interlukin – 6 at day 2, TNF ά at day 2 and 5,troponin I at day 5, and decreased
total hospital stay ( p < 0.05). Conclusion: Thoracic epidural anesthesia decreases stress and inflammatory
response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.
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Keywords
Coronary artery bypass grafting, inflammatory markers, off pump coronary artery bypass, thoracic, epidural anesthesia
Citation
Zawar Bhanu Prakash, Mehta Yatin, Juneja Rajiv, Arora Dheeraj, Raizada Arun, Treha Naresh. Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients. Annals of Cardiac Anaesthesia. 2015 Jul; 18(3): 385-391.