Anesteziol Reanimatol. 2011 Nov-Dec(6):8-12.
Aim of study is to compare efficiency and safety of different methods of combined inhalational and epidural anesthesia during aortocoronary bypass surgery on beating heart.
40 patients suffering from coronary heart disease were included in randomized study. Two methods of combined inhalational and epidural anesthesia were compared. The first group of 22 patients were administrated extended-release epidural anesthesia with Ropivacaine 0.3% in upper thoracic region and Sevoflurane as a volatile agent. Second group of 18 patients were administrated Isoflurane and epidural anesthesia. Monitoring: (Harvard standard of monitoring), BIS, invasive monitoring of hemodynamic, the dose of anesthetic gas, internal medical audit. Result of the study showed that all patient had same duration of surgery, level of unconsciousness (BIS 40-45%) dose of valiant anesthetic agents less than 1 MAC, same dose of Ropivacaine, minimal dose of opioids, quantity and quality of intravenous infusion therapy and same amount of vasopressors. It was discovered that Sevoflurane had influenced hemodynamic less than Isoflurane. The results of internal retrospective medical study showed safety of both methods of anesthesia. Sevoflurane allowed fast postoperative recovery on 1,74 times ,early extubation in theater on 1,64 times. Both methods of combined anesthesia epidural and inhalational presented good results and can be performed in coronary bypass surgery but for fast-track surgery and anesthesia use of Sevoflurane is better.
本研究的目的是比较在心脏不停跳的主动脉冠状动脉搭桥手术中不同联合吸入和硬膜外麻醉方法的效率和安全性。
40例冠心病患者纳入随机研究。比较了两种联合吸入和硬膜外麻醉方法。第一组22例患者在胸段上部给予0.3%罗哌卡因缓释硬膜外麻醉，并使用七氟醚作为挥发性麻醉剂。第二组18例患者给予异氟醚和硬膜外麻醉。监测：（哈佛监测标准），脑电双频指数（BIS），血流动力学有创监测，麻醉气体剂量，内部医学审计。研究结果显示，所有患者的手术时间、意识水平（BIS 40 - 45%）、有效麻醉剂剂量小于1个最低肺泡浓度（MAC）、罗哌卡因剂量相同、阿片类药物最低剂量、静脉输液治疗的量和质量以及血管升压药用量均相同。发现七氟醚对血流动力学的影响小于异氟醚。内部回顾性医学研究结果显示两种麻醉方法均安全。七氟醚使术后恢复速度快1.74倍，术中早期拔管快1.64倍。硬膜外和吸入联合麻醉的两种方法均取得了良好效果，可用于冠状动脉搭桥手术，但对于快速康复手术和麻醉，使用七氟醚更好。
