title: Thoracic epidural anesthesia decreases C-reactive protein levels in patients undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  Coronary artery bypass graft surgery with cardiopulmonary bypass induces a systemic inflammatory response. However, when thoracic epidural anaesthesia is administered as part of a combined anesthetic technique, the stress response associated with the cardiopulmonary bypass (CPB) may be attenuated.
  
  
  METHODS
  Twenty-two patients undergoing elective coronary artery bypass graft surgery were randomized to receive either balanced general anesthesia with 7-20 microg/kg fentanyl (GA group) or combined anesthesia with 3-6 microg/kg fentanyl and an epidural bolus of 0.33% bupivacaine followed by a continuous perfusion of 0.175% bupivacaine, which was continued up to 48 hours after surgery (TEA group). The hemodynamic levels, troponin I, C-reactive protein (CRP), fibrinogen, leukocyte and platelet counts were recorded preoperatively, and 5 h, 16 h, 24 h, and 36 h after termination of the cardiopulmonary bypass. The time to tracheal extubation and cardiopulmonary complication rate were measured postoperatively. Data were analyzed with the Student's t and Mann Whitney tests, as appropriate. Differences were considered significant at P<0.05.
  
  
  RESULTS
  All parameters significantly increased following CPB. The increase in CRP levels were lower in the TEA group at 16 hours (P=0.048). The increase of fibrinogen levels were lower in the TEA group at 24 hours (P=0.047). No differences were found in troponin levels between groups during the study. No significant differences were observed in extubation times (GA group 750+/-144 min; TEA group 702+/-451 min).
  
  
  CONCLUSIONS
  Thoracic epidural anaesthesia, as a part of a combined anesthetic technique, attenuated the inflammatory response (CRP and fibrinogen levels) to cardiac surgery with cardiopulmonary bypass. However, this effect was not reflected in a decrease of troponin I levels, reduced incidence of complications, or in an earlier extubation time.
authors.affiliation: Department of Anesthesiology, La Paz University Hospital, Madrid, Spain mapalomero@gmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: Palomero Rodríguez
authors.forename: L
authors.initials: L
authors.lastname: Suarez Gonzalo
authors.forename: F
authors.initials: F
authors.lastname: Villar Alvarez
authors.forename: C
authors.initials: C
authors.lastname: Varela Crespo
authors.forename: I
authors.initials: I
authors.lastname: Moreno Gomez Limon
authors.forename: A
authors.initials: A
authors.lastname: Criado Jimenez
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000032:analysis*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass; D005260:Female; D005283:Fentanyl; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D019210:Troponin I / Q000097:blood
chemical_list: D000779:Anesthetics, Local; D019210:Troponin I; D005340:Fibrinogen; D002097:C-Reactive Protein; D005283:Fentanyl; D002045:Bupivacaine