Sobokar V. Comparative evaluation of high thoracic epidural anesthesia and central analgesia during on-bypass coronary artery bypass grafting

In the 1990s central analgesia (CA) was considered method of choice in cardiac surgery because of its ability to provide hemodynamic stability during and after surgery. Now it has been supplanted by the modern "fast-track" methods, including high thoracic epidural analgesia (HTEA). The latter has several advantages, but it has not been common in Ukraine. Limiting factor may be fear of negative hemodynamic effects of epidural blockade in patients with heart disease. The aim of the study was improvement of the results of the surgical treatment by means of introduction of HTEA as a part of anesthesia care for the surgery. After cardio-pulmonary bypass and at the end of the surgery adrenaline excretion rate of the control group appreciably exceeded the corresponding value of the study group: 138,4±62,7 nmol·day-1 vs 91,7±42,5 nmol·day-1 (p < 0,01) and 135,6±59,4 nmol·day-1 vs 95,1±43,2 nmol·day-1 (p < 0,01). The norepinephrine excretion rate in the control group was also higher at these stages: respectively 231,5±96,1 nmol·day-1 vs 206,1±87,6 nmol·day-1 (p < 0,05) і 289,0±128,3 nmol·day-1 vs 193,9±78,7 nmol·day-1 (p < 0,01). Release of the troponin T on the 16-th hour after surgery in the study group was lower than that in the control 0,316±0,288 ng·ml-1 vs 0,548±0,477 ng·ml-1 (р < 0,05). HTEA use led to 4-fold fall of fentanil demand during the surgery, 40% decrease of postoperative ventilation time and 12 % shortening of ICU stay - from 6,6±3,7 days to 5,8±2,1 days (р < 0,05). We concluded that іntroducing the findings of the research in the anesthesiology practice allows improving the results of the on-bypass coronary surgery.