A PROSPECTIVE STUDY OF INTRAOPERATIVE COMPARISON BETWEEN GENERAL ANAESTHESIA WITH CONVENTIONAL OPIOID AND THORACIC EPIDURAL ANAESTHESIA FOR OFF PUMP CORONARY ARTERY BYPASS SURGERY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 20
Abstract
BACKGROUND Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity amongst cardiovascular diseases in both developed and developing countries. The prevalence of CAD in India is 14% in urban and 7.4% in rural populations. Perioperative advantage of TEA (thoracic epidural anaesthesia) is enhanced coronary perfusion, improved myocardial oxygen balance and reduced incidence of tachyarrhythmia and myocardial ischemia through sympatholysis. METHODS 108 patients for OPCAB were selected and divided into two groups (GA and GATE). In GATE group, Epidural insertion was done in the evening, 1 day before surgery. Neuraxial block was achieved from T1 to T10 segments with epidural 10 ml infusion of 0.5% bupivacaine with 0.5 mcg/kg fentanyl as bolus dose over a period of 10 minutes followed by infusion of 0.25% bupivacaine with fentanyl 2 mcg/ml@5 ml/hr intraoperatively. In GA Group, maintenance dose of intravenous fentanyl 1 mcg/kg + midazolam 0.03 mg/kg were given intermittently and when there was increase in mean arterial pressure or heart rate above 20% from the baseline. All patients were induced with Thiopental 2.5 mg/kg + Fentanyl 3 mcg/kg + Midazolam 0.03 mg/kg + Vecuronium 0.1 mg/kg, ventilated with 100 % O2 for 3 minutes and intubated with cuffed endotracheal tube of appropriate size. Before skin incision, injection fentanyl 1 mcg/kg, vecuronium 0.02 mg/kg were repeated and surgery was started. Anaesthesia was maintained with air (50%) + oxygen (50%) + isoflurane 1% dial conc.+ intermittent bolus dose of vecuronium 0.02 mg/kg. Heparin (150 IU/kg) was administered via central venous line after completion of LIMA harvesting to achieve an activated clotting time of 250– 350s. At the end of the surgery patient were shifted to CVTS-ICU and ventilated with SIMV volume control with pressure support mode. RESULTS Superior haemodynamic stability could be achieved via thoracic epidural anaesthesia. heart rate at baseline (p value= 0.563) and after induction (p value= 0.438) were similar and comparable in both the groups. There is more haemodynamic variability during circumflex or obtuse marginal anastomosis (GA - 85.78±7.32 & GATE -77.06±8.33). The median duration of surgery in GATE group is 5 hours 30 minutes (IQR- 0-1.00) which is significantly higher than GA group with 5 hours (IQR-0-0.63). In GATE group 83.34% of the patients were extubated earlier within 8 hours as compared to 62.96% in GA group. CONCLUSIONS We have observed that combined thoracic epidural anaesthesia with general anaesthesia reduces stress response to intubation, better perioperative haemodynamic stability and earlier extubation.
Authors and Affiliations
Nameirakpam Charan, Mangesh Chaudhary, Manish Sonkusale, Rashmi Deshpande
Keywords
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- EP ID EP619067
- DOI 10.14260/jemds/2019/368
- Views 49
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