On-pump cardiac surgery in a conscious patient using a thoracic epidural anesthesia--an ultra fast track method.
OBJECTIVE
To demonstrate the applicability and efficacy of spontaneous ventilation during cardiac surgery.


METHODS
From March 1999 through December 2002, 129 awake patients were operated on; 90 on-pump and 39 off-pump. A thoracic epidural space blockage was performed one hour prior to an incision being made at the Th 2-Th 4 level. Medial approach was used and the hanging drop method was routinely employed for epidural space detection.


RESULTS
There were 82 male and 47 female patients with a mean age of 64.5 years. Forty two cases were aortic valve replacement, 32 patients underwent on-pump coronary artery bypass grafting (CABG), 12 underwent mitral valve replacement, 27 patients were indicated for sternal wound reexploration, 12 for off-pump CABG, one for aortic valve replacement with aortic arch reconstruction and aortic valve replacement together with CABG was performed three times. There were ten conversions to general anesthesia and there was no death. Mean duration of the stay in the intensive care unit was 7.2 hours and in the hospital 5.1 days. We did not observe low cardiac output syndrome, stroke, renal insufficiency or pulmonary dysfunction in patients who sufficiently underwent thoracic epidural anesthesia. Less pain at assessments was demonstrated (Visual Analgetic Score=3.3).


CONCLUSIONS
The recent interest in rapid recovery and early out-patient care of patients after cardiac surgery has prompted investigations into the use of neuraxial analgesia for these procedures. The above mentioned technique would be beneficial for patients with preoperative pulmonary dysfunction and may be particularly useful in endoscopic cardiac surgery. (Tab. 1, Fig. 2, Ref. 18.)
Stritesky
M
M
Department of Anesthesiology, General Teaching Hospital, Charles University, 1st Medical Faculty, Prague, Czech Republic. martin.stritesky@lfl.cuni.cz
Semrad
M
M
Kunstyr
J
J
Hajek
T
T
Demes
R
R
Tosovsky
J
J
D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative