Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome.
The aim of the present investigation was to study the effects of intraoperative and postoperative epidural pain management during and after coronary artery bypass grafting (CABG) on the recovery time, postoperative pulmonary and cardiac parameters, visual analog scale (VAS) scores, and sedation scores (SS) compared with patients anesthetized with general anesthesia (GA) whose postoperative pain was relieved with intermittent intravenous (IV) administration of nicomorphine. Fifty-four patients were studied postoperatively after uncomplicated CABG. In the thoracic epidural analgesia (TEA) group (n = 27), intraoperative analgesia was based on high TEA in combination with GA. In the GA group (n = 27), IV anesthesia with high-dose sufentanil and midazolam was used. Postoperative pain management in the GA group consisted of intermittent IV administration of nicomorphine, 0.1 mg/kg every 6 hours, whereas for the TEA group continuous high TEA with 0.125% bupivacaine plus sufentanil, 1:1,000,000 (0.05 mL/cm body length/hr) was used. Patients in the TEA group awakened earlier (148 [34] minutes vs 335 [51] minutes), resumed spontaneous respiration earlier (326 [79] minutes vs 982 [52] minutes), and were extubated earlier (463 [79] minutes vs 1140 [58] minutes). VAS score, SS, and postoperative PaO2 were significantly (P less than or equal to 0.01) better in the TEA group. The incidence of tachycardia (15 vs 2 patients) and postoperative myocardial ischemia (12 vs 4 patients) was higher in the GA group. It is concluded that intraoperative and postoperative pain treatment with epidurally administered bupivacaine plus sufentanil improved the recovery time, as well as pulmonary and cardiac outcome after CABG, when compared with IV postoperative pain treatment after intraoperative GA with sufentanil and midazolam.
Liem
T H
TH
Institute of Anesthesiology, University of Nijmegen, The Netherlands.
Hasenbos
M A
MA
Booij
L H
LH
Gielen
M J
MJ
D015360:Analgesia, Epidural; D000771:Anesthesia, Intravenous; D002045:Bupivacaine; D001026:Coronary Artery Bypass; D005283:Fentanyl / Q000031:analogs & derivatives*; D006801:Humans; D007275:Injections, Intravenous; D008874:Midazolam; D009022:Morphine Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D009539:Nicotinic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control*; D011229:Preanesthetic Medication; D017409:Sufentanil; D016896:Treatment Outcome
D009022:Morphine Derivatives; D009539:Nicotinic Acids; D017409:Sufentanil; D008874:Midazolam; D005283:Fentanyl; D002045:Bupivacaine; C008549:nicomorphine