Coronary Artery Bypass Grafting without Cardiopulmonary Bypass: Improvement in Cardiac Function Following Enflurane Anaesthesia during Coronary Occlusion.
Severe adverse effects, especially neurologic complications after cardiopulmonary bypass have lead to the development of techniques for performing coronary artery bypass graft surgery without cardiopulmonary bypass. Laboratory and clinical studies confirmed the positive role of enflurane anaesthesia in preventing myocardial dysfunction following an ischaemic interval. The aim of this study was to evaluate the haemodynamic response to enflurane anaesthesia during single graft coronary bypass surgery without cardiopulmonary bypass. Twenty one patients were divided randomly into two groups: control and enflurane groups. Haemodynamic parameters and those derived from a pulmonary artery catheter were recorded and analysed. In the enflurane group, the amount of fentanyl administered was considerably less than in the control group: 25.7 +/- 3.8 microg/kg vs 36.8 +/- 1.6; p=0.03. The mean arterial pressure during enflurane administration was lower than in control group, but the difference was not significant. Despite a dearease in left ventricular function during the performance of the anastomosis in the enflurane group, a significant recovery was noted after 20 minutes of reperfusion: cardiac index increased from 1.4 +/- 0.1 to 1.85 +/- 0.1 L/min/m2 and left ventricular stroke work index from 15.8 +/- 1.1 to 27.7 +/- 6.7 g.m.m2 . In the control group, the deterioration in cardiac function observed during the graft anastomosis did not recover till the end of the surgical procedure. We conclude that enflurane anaesthesia may be a positive addition to fentanyl-based anaesthesia by improving myocardial function following CABG without bypass surgery.
Gozal
Y
Y
Department of Anaesthesiology and Critical Care Medicine, Hadassah University Hospital, Jerusalem, Israel. gozaly@md2.huji.ac.il.
Elami
A
A
Milgalter
E
E
Merin
G
G
Drenger
B
B