title: High thoracic epidural analgesia in cardiac surgery. Part 1--high thoracic epidural analgesia improves cardiac performance in cardiac surgery patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the perioperative cardioprotective effect of high thoracic epidural analgesia (HTEA), primarily expressed as an effect on cardiac performance and hemodynamics in patients undergoing cardiac surgery.
  
  
  METHODS
  A randomized, prospective study.
  
  
  METHODS
  Sixty low-to-moderate risk patients between the ages of 65 and 80 years scheduled for elective coronary artery bypass graft surgery with or without aortic valve replacement.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Patients randomized to receive HTEA as a supplement to general anesthesia.
  
  
  RESULTS
  Perioperative hemodynamic measurements, perioperative fluid balance, and postoperative release of cardiac enzymes were collected. The end-diastolic volume index (EDVI), the stroke volume index (overall 38 v 32 mL), the cardiac index (overall 2.35 v. 2.18 L/minute/m(2)), the central venous pressure, and central venous oxygenation were higher in the HTEA group. The mean arterial blood pressure was marginally lower in the HTEA group, whereas no difference was noted in the heart rate or peripheral saturation between the groups. No differences were found in the postoperative levels of troponin T and CK-MB between groups. NT-proBNP changed over time (p < 0.001) and was lower in the HTEA group (p = 0.013), with maximal values of 291 ± 265 versus 326 ± 274.
  
  
  CONCLUSIONS
  The findings of a higher stroke volume index and central venous oxygenation without an increase in heart rate or mean arterial pressure suggest that HTEA improves cardiac performance in elderly cardiac surgery patients.
authors: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus, Denmark. cjj@cale.dk
authors: Carl-Johan
authors: CJ
authors: Jakobsen
authors: Rajesh
authors: R
authors: Bhavsar
authors: Dorthe Viemose
authors: DV
authors: Nielsen
authors: Pia Katarina
authors: PK
authors: Ryhammer
authors: Erik
authors: E
authors: Sloth
authors: Jacob
authors: J
authors: Greisen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013904:Thoracic Vertebrae