Anesthesia strategy for surgery with beating heart. Five years of experience at the “Ernesto Che Guevara” Cardiology Hospital
Keywords:
anesthesia, thoracic surgery, myocardial revascularizationAbstract
Introduction and Objectives: The anesthesia in coronary surgery, using high sustained doses of fentanyl, leads to protracted postoperative extubation and stay. The assessment of an anesthesia strategy for coronary surgery without extracorporeal circulation, in order to reduce the use of opioids and make possible an early extubation and a shorter post-surgical stay, was the objective of this work. Methods: 732 patients who underwent surgical myocardial revascularization without heart-lung machine, from February 2003 to December 2007, using general anesthesia with intermittent boluses of fentanyl, with or without associated epidural anesthesia, were studied. Results: 625 surgical operations with general anesthesia in boluses and 107 adding peridural anesthesia were carried out. The average amount of fentanyl was 34.7 ml per patient in the first group and 24.9 ml when adding peridural anesthesia. Twenty seven patients were extubated in the operating room. The total average time was 8.6 hours (8.8 hours in the group where the anesthesia in boluses was used and 6.7 hours for those with peridural anesthesia associated). The total average stay at the Intensive Care Unit was 40.1 hours. Conclusions: The intermittent anesthesia reduced the amount of fentanyl used in 86.6 percent when compared to the high sustained doses reported in a previous study. This made possible the early extubation of the patients, which increased due to the use of peridural anesthesia, and a decrease in average stay of the patient at the Intensive Care Unit.
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References
1. Cartier R, Brann S, Dagenais F, Martineau R, Couturier A. Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases. J Thorac Cardiovasc Surg. 2000;119:221-9.
2. Chassot PG, Van Der Linden P, Zaugg M, Mueller XM, Spahn DR. Off-pump coronary artery bypass surgery: Physiology and anaesthetic management. Br J Anaesth. 2004 Mar;92(3):400-13.
3. Konety SH, Rosenthal GE, Vaughan-Sarrazin MS. Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter? J Thorac Cardiovasc Surg. 2009;137(5):1116-23.
4. Fajardo-Egozcue I, González O, Mesa JC, Hidalgo P, Lastayo R, Lagomasino A. Anestesia de recuperación rápida para cirugía coronaria con el corazón latiendo. An Cir Cardiac Vasc (Barcelona). 2005;11(1):16-20.
5. Fajardo Egozcue IR. Agentes anestésicos inhalatorios. En: Dávila Cabo de Villa E, Gómez Brito C, Álvarez Barzaga M, Sainz Cabrera H, Molina Lois RM. En: Anestesiología clínica. La Habana: ECIMED; 2008. Disponible en: http://bvs.sld.cu/libros_texto/anestesia_clinica/tema8.pdf
6. Couture P, Denault A, Blair R, Limoges P, Cartier R. Anesthesia for off-pump coronary artery by pass (OPCABG) surgery: Experience at the Montreal Heart Institute. Anesthesiol Rds. 2004;3(7):122-8.
7. Hemmerling TM, Prieto I, Choiniere JL, Basile F. Ultra fast track anesthesia in off pump coronary artery by pass grafting, a prospective audit comparing opioid based anesthesia vs thoracic epidural based anesthesia. Can J Anaesth. 2004;51:163-8.
8. Royse C, Royse A, Soeding Pl. Prospective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery. Ann Thorac Sur. 2003 Jan;75:93-100.
9. Kessler P, Aybek T, Neidhart G. Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: General anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone. J Cardiothorac Vasc Anesth. 2005; 19:32-9.
10. Hemerling T, Choiniëre Jl, Basile F, Prieto I. Regional anesthesia in cardiac surgery and immediate extubation after cardiac surgery: a different view. Can J Anesth. 2005;52:883.
11. Virmani J. Off-Pump coronary artery surgery. Annals Cardiac Anaesthesiol. 2007;10: 65-71.
12. Hamamsy I, Cartier R, Demers P, Bouchard D, Pellerin M. Long-Term Results After Systematic Off-Pump Coronary Artery Bypass Graft Surgery in 1000 Consecutive Patients. Circulation. 2006;114:I486-91.
13. Raja SG. OPCAB and the incidence of atrial fibrillation: ignoring the current best available evidence. Eur J Cardiothrac Surg. 2005 May 1;27(5):930-6.
14. Raja S, Behranwala A, Dunning J. Does off-pump coronary artery surgery reduce the incidence of postoperative atrial fibrillation? Interact CardioVasc Thorac Surg. 2004;3:647-52.
15. Salvi L, Parolari A, Veglia F, Brambillasca C, Gregu S, Sisislo E. High Thoracic Epidural Anesthesia in Coronary Artery Bypass Surgery: A Propensity-Matched Study. J Card Thoracic Vasc Anesthesiol. 2007;21:810-5.
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