High thoracic epidural anesthesia in coronary artery bypass surgery: a propensity-matched study.
OBJECTIVE
To assess if 2 different anesthesia strategies, high-thoracic epidural anesthesia (HTEA) plus inhalation anesthesia and total intravenous anesthesia (TIVA) with sufentanil/propofol had different influence on outcomes of coronary artery bypass graft (CABG) surgery patients.


METHODS
Retrospective comparison of outcomes between HTEA and TIVA patients using propensity score pair-wise matching of patients.


METHODS
A university teaching hospital.


METHODS
A study of 1,473 consecutive patients undergoing elective CABG surgery; of these, 476 (32%) received HTEA combined with inhalation anesthesia, whereas 997 (68%) underwent TIVA alone.


METHODS
The patients undergoing CABG surgery were offered the epidural-inhalation anesthetic approach.


RESULTS
Propensity matching yielded 389 pairs of patients. Patients were well matched in preoperative and operative features. Postoperative mortality, myocardial infarction, stroke, acute renal failure rates, and intensive care unit (ICU) stay were not statistically different in HTEA and TIVA groups. On the other hand, patients treated with HTEA had shorter ventilation times (5.8 +/- 3.11 v 6.9 +/- 5.0 hours, HTEA and TIVA, respectively, p < 0.001); in addition, vasoconstrictors were more frequently used in cases of HTEA, whereas vasodilators were mainly used with TIVA both intra- and postoperatively. No neurologic complications related to the use of HTEA were observed.


CONCLUSIONS
HTEA and TIVA provided similar early outcomes after CABG surgery, and there were no major differences between these 2 strategies in the average risk CABG patient populations. Although HTEA did not cause neurologic problems and yielded a significant reduction in time to extubation, a consistent benefit over standard techniques could not be shown.
Salvi
Luca
L
Department of Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy. luca.salvi@ccfm.it <luca.salvi@ccfm.it>
Parolari
Alessandro
A
Veglia
Fabrizio
F
Brambillasca
Claudio
C
Gregu
Sebastiana
S
Sisillo
Erminio
E
D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012189:Retrospective Studies; D013904:Thoracic Vertebrae; D013997:Time Factors; D016896:Treatment Outcome