Coronary artery disease and upper abdominal surgery: impact of anesthesia on perioperative myocardial ischemia.
OBJECTIVE
Some papers claim that epidural anesthesia and analgesia lowers the incidence of perioperative ischemic events and may have a favorable effect on perioperative cardiac morbidity and mortality. We studied the effect of epidural anesthesia and analgesia on perioperative myocardial ischemia, in a group of patients with known coronary artery disease, who underwent upper abdominal surgery.


METHODS
Fifty patients with coronary artery disease scheduled for elective upper abdominal surgery, were randomized to two study groups: Group A (n = 25) received general anesthesia plus epidural anesthesia and analgesia, while group B (n = 25) received general anesthesia with postoperative i.v. analgesia. All patients had Holter ECG recording from 24 hours preoperatively until 48 hours postoperatively.


RESULTS
Preoperatively, no significant differences in ischemic burden were observed between the two groups. Intraoperatively, significantly fewer patients in group A had ischemic episodes (8% vs. 36%, p < 0.05) and there was also a significant reduction in the number of ischemic episodes and in mean duration of ischemia per hour of monitoring. Similar findings were observed in the first 24 hours postoperatively but not later on, with 12% of patients in group A having ischemic episodes vs. 60% in group B (p < 0.01). Group A had significantly better pain control postoperatively. Only one third of ischemic episodes were related to hemodynamic abnormality, and most of them were clinically silent. No serious cardiac morbidity or mortality was observed during the period of monitoring.


CONCLUSIONS
Epidural anesthesia and analgesia reduces intraoperative and early postoperative ischemia in patients with known coronary artery disease undergoing upper abdominal surgery.
Limberi
Sotiria
S
Anesthesiology Department of Ippokration General Hospital of Athens, Athens, Greece.
Markou
Nikolaos
N
Sakayianni
Katerina
K
Vourliotou
Anastasia
A
Kremastinou
Fani
F
Savari
Eleni
E
Gregorakos
Leonidas
L
D000368:Aged; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D002763:Cholecystectomy; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D015716:Electrocardiography, Ambulatory / Q000187:drug effects*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology*; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*
D000701:Analgesics, Opioid; D009020:Morphine