title: Epidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage.
abstract: High thoracic epidural anesthesia/analgesia (HTEA) for coronary artery bypass grafting (CABG) surgery may have myocardial protective effects. In this prospective randomized controlled study, we investigated the effect of HTEA for elective CABG surgery on the release of troponin I, time to tracheal extubation, and analgesia. One-hundred-twenty patients were randomized to a general anesthesia (GA) group or a GA plus HTEA group. The GA group received fentanyl (7-15 microg/kg) and a morphine infusion. The HTEA group received fentanyl (5-7 microg/kg) and an epidural infusion of ropivacaine 0.2% and fentanyl 2 microg/mL until postoperative Day 3. There were no differences in troponin I levels between study groups. The time to tracheal extubation [median (interquartile range)] in the HTEA group was 15 min (10-320 min), compared with 430 min (284-590 min) in the GA group (P < 0.0001). Analgesia was improved in the HTEA group compared with the GA group. Mean arterial blood pressure poststernotomy and systemic vascular resistance in the intensive care unit were lower in the HTEA group. We conclude that HTEA for CABG surgery had no effect on troponin release but improved postoperative analgesia and was associated with a reduced time to extubation.
authors.affiliation: Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barrington
authors.forename: Roman
authors.initials: R
authors.lastname: Kluger
authors.forename: Robert
authors.initials: R
authors.lastname: Watson
authors.forename: David A
authors.initials: DA
authors.lastname: Scott
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Harris
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D009202:Cardiomyopathies / Q000097:blood*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology; D015742:Propofol; D011446:Prospective Studies; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D018686:Anesthetics, Intravenous; D015415:Biomarkers; D020107:Troponin T; D014665:Vasodilator Agents; D003402:Creatine Kinase; D015742:Propofol