title: High thoracic epidural anesthesia for off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  To assess the feasibility of high thoracic epidural anesthesia combined with sevoflurane for off-pump coronary artery bypass surgery and to evaluate the postoperative pain control, side effects, and perioperative hemodynamics.
  
  
  METHODS
  Retrospective review of prospectively collected data.
  
  
  METHODS
  A university teaching hospital.
  
  
  METHODS
  One hundred six consecutive patients receiving thoracic epidural combined with sevoflurane.
  
  
  METHODS
  From November 1999, the patients undergoing off-pump coronary artery bypass grafting were offered the epidural-inhalation anesthetic approach.
  
  
  RESULTS
  Insertion of the epidural catheter was successful in all but 2 patients; 1 bloody tap occurred and the dura was never punctured, although 1 patient presented with postoperative paraplegia. An emergency spinal cord nuclear magnetic resonance excluded signs of medullary compression caused by epidural or spinal hematoma. Visual analog scale scores for pain during the first 24-hour period were < 2 in all patients. Mean time to extubation was 4.6 +/- 2.9 hours. The average intensive care unit stay was 1.5 +/- 0.8 days. Incidences of perioperative myocardial infarction, myocardial ischemia, and atrial fibrillation were 2.8%, 7.5%, and 10.6%, respectively. Two patients died: 1 from multiorgan failure and the other from myocardial infarction. Heart rate, mean arterial pressure, cardiac index, and systemic vascular resistance were not affected by thoracic epidural alone. Mean arterial pressure and cardiac index decreased (p < 0.05) when general anesthesia was induced and remained stable thereafter. Neither heart rate nor systemic vascular resistance changed from baseline during operation.
  
  
  CONCLUSIONS
  Thoracic epidural as an adjunct to general anesthesia is a feasible technique in off-pump coronary artery bypass surgery. It induces intense postoperative analgesia and does not compromise central hemodynamics.
authors.affiliation: Department of Anesthesia and Intensive Care, URCCS, Centro Cardiologico Monzino, Milan, Italy. luca.salvi@ccfm.it
authors.forename: Luca
authors.initials: L
authors.lastname: Salvi
authors.forename: Erminio
authors.initials: E
authors.lastname: Sisillo
authors.forename: Claudio
authors.initials: C
authors.lastname: Brambillasca
authors.forename: Glauco
authors.initials: G
authors.lastname: Juliano
authors.forename: Stefano
authors.initials: S
authors.lastname: Salis
authors.forename: Maria R
authors.initials: MR
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain