Epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery.
OBJECTIVE
The purpose of this study was to evaluate the effects of thoracic epidural anesthesia on postoperative N-terminal pro B-natriuretic peptide (NT-proBNP) release in elderly patients undergoing elective coronary artery bypass graft (CABG) surgery.


METHODS
A case-matched, nonrandomized study.


METHODS
A university hospital, single institution.


METHODS
46 consecutive and 46 control patients.


METHODS
Ninety-two elderly patients (>65 years old) undergoing elective CABG surgery were recruited. Forty-six patients receiving general and epidural anesthesia were case matched (preoperative medications, ejection fraction, and comorbidities) with 46 control subjects receiving general anesthesia. The primary outcome measure was postoperative NT-proBNP release. The preoperative or intraoperative variables significantly associated with an intensive care unit stay longer than 4 days were determined by logistic regression.


RESULTS
The median (interquartile range) plasma concentrations of NT-proBNP before surgery were 402 (115-887 pg/mL) in the epidural group versus 508 (228-1,285 pg/mL) in the general anesthesia group (p = 0.9), whereas 24 hours after surgery it increased to 1846 (1,135-3,687 pg/mL) versus 5,005 (2,220-11,377 pg/mL) (p = 0.001), respectively. There were more patients (p = 0.043) in the control group (9/46 = 19.5%) than in the thoracic epidural anesthesia group (4/46 = 8.8%) with an intensive care unit stay longer than 4 days. The absence of preoperative beta-blocker therapy (odds ratio = 3.94; 95% confidence interval, 1.123-13.833; p =0.03) and of an epidural catheter (odds ratio = 3.91; 95% confidence interval, 1.068-14.619; p = 0.04) were the only preoperative and intraoperative variables independently associated with a prolonged intensive care unit stay.


CONCLUSIONS
Epidural anesthesia added to general anesthesia for CABG surgery significantly attenuates NT-proBNP release in elderly patients and reduces the incidence of prolonged intensive care unit stay.
Crescenzi
Giuseppe
G
Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
Landoni
Giovanni
G
Monaco
Fabrizio
F
Bignami
Elena
E
De Luca
Monica
M
Frau
Giovanna
G
Rosica
Concetta
C
Zangrillo
Alberto
A
D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain