Ysasi A, Llorens R, Calderón E, Wendt T, Trujillo M J, Herrero E, Gracia N
Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospitén Rambla, Santa Cruz de Tenerife.
Rev Esp Anestesiol Reanim. 2007 Oct;54(8):499-502.
Thoracic epidural anesthesia has been widely used to complement general anesthesia in coronary artery bypass grafting. The main advantages of the combination are excellent pain control and a less pronounced stress response to surgery. The invasiveness of surgery to treat ischemic heart disease has been attenuated thanks to the use of the mini-sternotomy and coronary anastomosis without extracorporeal circulation. In 4 patients, coronary artery revascularization was carried out via a mini-sternotomy, grafting the anterior descending artery to the left internal thoracic artery under high thoracic epidural anesthesia (block of segments T1-T8) with a perfusion of 0.75% ropivacaine and fentanyl in a conscious patient. There were no hemodynamic or respiratory complications during surgery. The mean duration of stay in the intensive care unit was less than 18 hours and the mean hospital stay was less than 5 days. Postoperative coronary arteriograms demonstrated the patency of all grafts and all patients were asymptomatic at 1 month. Our initial experience suggests that the use of only high thoracic epidural anesthesia is feasible in coronary revascularization in selected, cooperative patients who require a single coronary bypass graft.
胸段硬膜外麻醉已被广泛用于冠状动脉搭桥手术中辅助全身麻醉。联合使用的主要优点是出色的疼痛控制以及对手术的应激反应较轻。由于采用了微创胸骨切开术和非体外循环下的冠状动脉吻合术，治疗缺血性心脏病手术的侵袭性已有所减轻。在4例患者中，通过微创胸骨切开术进行冠状动脉血运重建，在胸段硬膜外麻醉（T1-T8节段阻滞）下，在清醒患者中用0.75%罗哌卡因和芬太尼灌注，将前降支动脉移植至左胸廓内动脉。手术期间未出现血流动力学或呼吸并发症。在重症监护病房的平均停留时间少于18小时，平均住院时间少于5天。术后冠状动脉造影显示所有移植血管通畅，所有患者在1个月时均无症状。我们的初步经验表明，对于需要单支冠状动脉搭桥的选定、配合良好的患者，仅使用胸段硬膜外麻醉进行冠状动脉血运重建是可行的。
