Salvi Luca, Sisillo Erminio, Brambillasca Claudio, Juliano Glauco, Salis Stefano, Marino Maria R
Department of Anesthesia and Intensive Care, URCCS, Centro Cardiologico Monzino, Milan, Italy.
J Cardiothorac Vasc Anesth. 2004 Jun;18(3):256-62. doi: 10.1053/j.jvca.2004.03.002.
To assess the feasibility of high thoracic epidural anesthesia combined with sevoflurane for off-pump coronary artery bypass surgery and to evaluate the postoperative pain control, side effects, and perioperative hemodynamics.
Retrospective review of prospectively collected data.
A university teaching hospital.
One hundred six consecutive patients receiving thoracic epidural combined with sevoflurane.
From November 1999, the patients undergoing off-pump coronary artery bypass grafting were offered the epidural-inhalation anesthetic approach.
Insertion of the epidural catheter was successful in all but 2 patients; 1 bloody tap occurred and the dura was never punctured, although 1 patient presented with postoperative paraplegia. An emergency spinal cord nuclear magnetic resonance excluded signs of medullary compression caused by epidural or spinal hematoma. Visual analog scale scores for pain during the first 24-hour period were < 2 in all patients. Mean time to extubation was 4.6 +/- 2.9 hours. The average intensive care unit stay was 1.5 +/- 0.8 days. Incidences of perioperative myocardial infarction, myocardial ischemia, and atrial fibrillation were 2.8%, 7.5%, and 10.6%, respectively. Two patients died: 1 from multiorgan failure and the other from myocardial infarction. Heart rate, mean arterial pressure, cardiac index, and systemic vascular resistance were not affected by thoracic epidural alone. Mean arterial pressure and cardiac index decreased (p < 0.05) when general anesthesia was induced and remained stable thereafter. Neither heart rate nor systemic vascular resistance changed from baseline during operation.
Thoracic epidural as an adjunct to general anesthesia is a feasible technique in off-pump coronary artery bypass surgery. It induces intense postoperative analgesia and does not compromise central hemodynamics.
评估高胸段硬膜外麻醉联合七氟醚用于非体外循环冠状动脉搭桥手术的可行性，并评价术后疼痛控制、副作用及围手术期血流动力学情况。
对前瞻性收集的数据进行回顾性分析。
一所大学教学医院。
106例连续接受胸段硬膜外联合七氟醚麻醉的患者。
自1999年11月起，为接受非体外循环冠状动脉搭桥术的患者采用硬膜外-吸入麻醉方法。
除2例患者外，硬膜外导管置入均成功；发生1次血性穿刺，未出现硬膜穿破情况，尽管有1例患者术后出现截瘫。急诊脊髓核磁共振排除了硬膜外或脊髓血肿导致的髓质压迫迹象。所有患者术后24小时内疼痛视觉模拟评分均<2分。平均拔管时间为4.6±2.9小时。平均重症监护病房停留时间为1.5±0.8天。围手术期心肌梗死、心肌缺血和房颤的发生率分别为2.8%、7.5%和10.6%。2例患者死亡：1例死于多器官功能衰竭，另1例死于心肌梗死。单纯胸段硬膜外麻醉对心率、平均动脉压、心脏指数和全身血管阻力无影响。诱导全身麻醉时平均动脉压和心脏指数下降（p<0.05），此后保持稳定。术中心率和全身血管阻力与基线相比均未改变。
胸段硬膜外麻醉作为全身麻醉的辅助手段，在非体外循环冠状动脉搭桥手术中是一种可行的技术。它可产生强烈的术后镇痛效果，且不影响中心血流动力学。
