scholarly journals Requirement of Postoperative Ventilation and analgesics during Off-Pump Coronary Artery Bypass (OPCAB) surgery – A Comparison between Combined High Thoracic Epidural Anaesthesia (HTEA) with GA and GA Alone

2021 ◽  
Vol 36 (2) ◽  
pp. 74-81
Author(s):  
SI Azad ◽  
AK Beg
Keyword(s):  
Mechanical Ventilation ◽  
Coronary Artery ◽  
Pain Score ◽  
Artery Bypass ◽  
Time Interval ◽  
Thoracic Epidural ◽  
Icu Stay ◽  
Group A ◽  
High Thoracic Epidural ◽  
Group B

Beckground: This is often difficult to achieve optimal pain relief after coronary artery bypass surgery and also great challenge to choice appropriate analgesics with minimize the duration of mechanical ventilation. In the postoperative period inadequate analgesia may increase morbidity by causing adverse haemodynamic, metabolic, immunologic and haemostatic attentions and prolong mechanical ventilation with more ICU stay. High Thoracic Epidural Anaesthesia (HTEA) as an adjunct to general anaesthesia has been shown to be potentially beneficial in postoperative pain relief and the requirement of mechanical ventilationin patients with off-pump coronary artery bypass surgery (OPCAB). HTEA provides good protection from stress response, ensures hemodynamic stability, improves distribution of coronary blood flow with reducing demand of oxygen, less requirement of postoperative analgesia , mechanical ventilation and ICU stay. Objective: This study has been undertaken with a view to compare requirement of postoperative mechanical ventilation and analgesics in OPCAB surgery between HTEA with GA and GA alone. Methods: This prospective, randomized case control comparative study was carried out in sixty patients without having left main coronary artery disease, left ventricular ejection fraction <30% or contraindication of regional anaesthesia scheduled for OPCAB. They were divided into two groups, thirty in each group. Group A received GA alone and group B received high thoracic epidural anaesthesia with GA. Requirement of postoperative analgesics, pain score, consciousness score, sedation score, satisfection level and duration of ventilation with length of stay in intensive care unit were recorded in the post-operative period. Results: Rescue analgesics received and found 16(53.3%) and 6(20.0%) needed analgesia in group A and group B respectively and the difference was statistically significant (p<0.05). Regarding the pain score (VAS) during maintenance with ventilator with awareness at first fourth hour significant (p<0.05) change between two groups. After extubation at rest in different time interval and found significant (p<0.05) change between two groups in all follow-up times. Post-operative pain score (VAS) after extubation at movement in different time interval and found significant (p<0.05) change between two groups. Post-operative pain score (VAS) after extubation at during coughing in different time interval and found significant (p<0.05) change between two groups. Post-operative sedation score at first six hour (hourly) and found significant (p<0.05) change between two groups except 1st hour, which was not significant (p>0.05). The mean extubation hours were 7.4±1.09 hours in group A and 5.3±0.81 hours in group B. The mean ICU stay was 72.9±9.2 hours in group A and 57.1±12.0 hours in group B and the difference was statistically significant (p<0.05) in unpaired t-test. No postoperative complication was observed in both groups. Conclusion: HTEA with GA appeared to be most reliable postoperative pain relief, shorter mechanical ventilation, ICU stay in OPCAB surgery Bangladesh Heart Journal 2021; 36(2): 74-81

Thoracic Epidural Anesthesia for Coronary Bypass Surgery Affects Autonomic Neural Function and Arrhythmias

2005 ◽  
Vol 1 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Noriyoshi Yashiki ◽  
Go Watanabe ◽  
Shigeyuki Tomita ◽  
Satoru Nishida ◽  
Tamotsu Yasuda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
General Anesthesia ◽  
Sympathetic Activity ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Thoracic Epidural ◽  
Group A ◽  
Group B

Background In recent years, the invasiveness of coronary reconstruction has been markedly reduced. Awake off-pump coronary artery bypass (AOCAB), coronary bypass surgery with thoracic epidural anesthesia (TEA) without general anesthesia and cardiopulmonary bypass), has been reported in the literature. Because the details of this technique are still unclear, we evaluated its usefulness by examining the autonomic neural state and the incidence of arrhythmia. Methods Fifty-five patients who underwent elective coronary artery bypass grafting (CABG) between April and December 2003 were included in the study. Patients who underwent CABG under high TEA alone comprised group A, those who underwent CABG under general anesthesia combined with TEA comprised group B, and those who underwent CABG under general anesthesia alone comprised group C. Holter electrocardiography was performed before and after surgery, and perioperative electrocardiograms were recorded (before surgery and during surgery, postoperative days 0–3, and postoperative day 7). On obtained electrocardiograms, the autonomic neural state was evaluated by analysis of heart rate variability, and the incidence of atrial fibrillation. Results Concerning the autonomic neural state, sympathetic inhibition was observed during TEA in both groups A and B. After discontinuation of TEA, sympathetic activity recovered. Vagal activity was not inhibited in group A, but decreased during surgery and gradually recovered after surgery in group B. Evaluation of the balance between sympathetic and vagal activities showed that sympathetic activity became predominant rapidly on postoperative day 2 in group B but gradually after surgery in group A. The incidence of postoperative atrial fibrillation was the highest in group B. Conclusions In AOCAB, because there is no vagal inhibition, vagal dominance can be maintained after surgery. This may be associated with the lower incidence of postoperative atrial fibrillation in group A compared with group B. Further studies are necessary to evaluate the details of AOCAB.

scholarly journals Early Post operative Pain Management and Early Extubation after Off-pump Coronary Artery Bypass Graft Surgery is better managed with Thoracic Epidural Analgesia

2017 ◽  
Vol 9 (2) ◽  
pp. 142-146
Author(s):  
Naresh Chandra Mandal ◽  
Md Fidah Hossain ◽  
Nirmal Kanti Dey ◽  
Md Motiur Rahman Sarkar ◽  
Abdullah Al Mamun ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Epidural Analgesia ◽  
Artery Bypass ◽  
Thoracic Epidural Analgesia ◽  
Off Pump ◽  
Thoracic Epidural ◽  
Post Operative Pain ◽  
Group A ◽  
Pump Coronary Artery Bypass ◽  
Group B

Background: Off-pump coronary artery bypass (OPCAB) graft surgery is the commonest operation worldwide. Sternotomy, pleurotomy with opening of the pleural space, harvesting of internal mammary artery may lead to severe post-operative pain. Thoracic epidural analgesia (TEA) may reduced significant post-operative pain & allow the patient early extubation.Methods: A total of 60 patients with ischaemic heart disease (IHD) were included in the study who were admitted in the Department of Cardiac Surgery in NICVD, Dhaka from July 2006 to June 2008 & underwent off-pump coronary artery bypass (OPCAB) graft surgery. Out of the total 60 patients, 30 were in the group-A receiving thoracic epidural analgesia along with general anaesthesia and the rest 30 were in the group-B receiving general anaesthesia alone.Results: Patients in the epidural group had significantly less pain on the operative day and for the next 2 days. Total ventilation time in hours in Group-A was 6.4 + 1.0 and in Group-B was 10.1 +1.8 hours respectively. Postoperative X-ray chest revealed significant pulmonary complication in Group- B than Group-A. There were no complications related to epidural haematoma and no permanent neurological squeal.Conclusion: Thoracic epidural analgesia reduced significant post-operative pain and improvement in pulmonary function and early extubation.Cardiovasc. j. 2017; 9(2): 142-146

scholarly journals Cardiac Drugs Requirement during Off-Pump Coronary Artery Bypass (OPCAB) Surgery- A Comparison between Combined High Thoracic Epidural Anaesthesia (HTEA) with GA and GA Alone

1970 ◽  
Vol 3 (1) ◽  
pp. 7-10
Author(s):  
SI Azad ◽  
AK Beg ◽  
AYFE Chowdhury
Keyword(s):  
General Anaesthesia ◽  
Epidural Anaesthesia ◽  
Artery Bypass ◽  
Off Pump ◽  
Thoracic Epidural ◽  
Thoracic Epidural Anaesthesia ◽  
Group A ◽  
High Thoracic Epidural ◽  
Pump Coronary Artery Bypass ◽  
Group B

Background: During off pump coronary artery bypass surgery (OPCAB) to provide adequate myocardial protection cardiac anaesthesiologist frequently needs to use various pharmacological intervention rather than physiological manipulation. This is challenging to overcome the adverse effects of the various drugs. During the past few years, high thoracic epidural anaesthesia (HTEA) as an adjunct to general anaesthesia has become more popular and has been shown to be potentially beneficial in patients with coronary diseases. It provides good protection from stress response, ensures hemodynamic stability, improves distribution of coronary blood flow and reduce demand for oxygen and perioperative arrhythmia. Objective: This study has been undertaken with a view to compare the requirement of intraoperative cardiac drugs between HTEA with General Anaesthesia(GA) and GA alone. Methods: Prospective, randomized case control study was undertaken in sixty patients, without having left main coronary disease, left ventreicular ejection fraction <35% or contraindication of regional anaesthesia scheduled for OPCAB. They were divided into two groups, thirty in each group. Group A patients received GA alone and group B patients received high thoracic epidural anaesthesia with GA. Requirement of drugs (antiarrhythmic, inotropes, vasoconstrictor, vasodilators,Esmolol e.g.) during operation were recorded. Results: Dopamine was needed in 27(90.0%)patients in group A and 11(36.7%) patients in group B, adrenaline was used in 15(50.0%)patients in group A and 4(13.3%) in group B; Dobutamine was used only in 5(15.0%) patients in group A and ephedrine was required only in 2(5.0%) in group B. Regarding the Antiarrhythmic drugs, Lignocanie, Amiodarone and DC Shock was required only in 17(55.0%), 12(40.0%) and 5(15.0%) patients respectively only in group A. In vasodilators group, Nitropruside was used in 5(15.0%) and 1(3.3%) patients in group A and group B respectively. Esmolol was used in 17(55.0%) patients in group A and 1(3.3%) in group B. Significant (p<0.05) difference were found in use of all drugs between two groups except Ephedrine and Nitropruside. Conclusion: The anaesthetic technique HTEA with GA required minimum intra operative cardiac drugs than GA only. Key words: Cardiac drug; HTEA; General Anaesthesia; OPCAB. DOI: 10.3329/cardio.v3i1.6420Cardiovasc. j. 2010; 3(1): 7-10

scholarly journals Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

2018 ◽  
Vol 10 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Tawfiq Ahmed ◽  
Md Rezaul Karim ◽  
Jahangir Haider Khan ◽  
Shahriar Moinuddin
Keyword(s):  
Coronary Artery ◽  
Postoperative Period ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Neurocognitive Dysfunction ◽  
Off Pump ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Objective: The Neurological injury is an important complication after coronary artery bypass surgery (CABG). The incidence of neurocognitive impairment after cardiac surgery varies from 20% to 80%. In this study we tried to analyze this difference of neurologic dysfunction between On-pump CABG and Off-pump CABG (OPCAB).Methods:This is a case control study done in National Institute of Cardiovascular Disease (NICVD), Dhaka during the period of July 2012 to June 2014. Sixty Patients with Ischemic heart disease were the study population. Group- A includes 30 patients underwent on pump CABG, Group-B 30 patients underwent OPCAB. All the patients of both the groups were followed up to 2 month’s postoperatively to find out any neurological and neurocognitive dysfunctionby observing motor function, sensory function,Mini Mantel state (MMS) Examination, orientation, memory, attention and calculation, recall and language test.Results: Neurocognitive dysfunction in the early postoperative period is significantly different among the groups.Neurocognitive dysfunction was more in Group A in comparison to Group B, On 3rd and 8th POD the MINI Mental Scores were found to be significantly lower in On-pump group than those in Off-pump group (22.0 ± 5.28 vs. 25.67 ± 3.34, p = 0.002 and 25.93 ± 3.11 vs. 26.63 ± 2.50, p = 0.023 respectively).This neurocognitive dysfunction gradually improved by the end of two month postoperative period. Only 6.66% patient in Group-A was found neurocognitically dysfunctional and was referred to neurophysician for further treatment. In case of OPCAB Group, no patient suffered fromneuorocognitive dysfunction.Conclusion: This study has convincingly shown cardio-pulmonary bypass (CPB) has had detrimental effect on neurocognitive function in patients who underwent CABG.Cardiovasc. j. 2018; 10(2): 186-193

P1832Myocardial injury assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. a pre-specified analysis of mass V trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A R Dallazen ◽  
W Hueb ◽  
P C Rezende ◽  
G A B Boros ◽  
F F Ribas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
T1 Mapping ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Native T1 ◽  
Before And After ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Abstract Background Myocardial structural damage may occur during coronary artery bypass grafting (CABG) surgery and is identified by the significant release of cardiac biomarkers. However, the evidence of these structural myocardial changes after CABG by current imaging methods remains unknown. To evaluate myocardial structure, we used the T1 mapping of cardiac magnetic resonance (CMR) before and after on-pump and off-pump CABG. Methods Patients with multivessel coronary artery disease and preserved ventricular function were included and underwent on or off-pump CABG. CMR and T1 mapping were performed using the MOLLI technique (modified Look-Locker inversion-recovery). Values of native T1 and extracellular volume fraction (ECV) were compared before and after on and off-pump procedures. Results Of 110 eligible patients, 34 were excluded due to the presence of new late enhancement or edema. Of 76 patients remained, 32 (42%) underwent on-pump (Group A) and 44 (58%) off-pump CABG (Group B). All baseline characteristics were similar between groups, besides the Syntax Score that was higher in Group A (25 × 21, p=0.002). For group A, native T1 before and after procedures was 1013 ms (998–1043) and 1004 ms (793–1048), p=0.19, and ECV was 26.4 (23.9–27.6) and 31.2 (27.6–33.9), p<0.001. For group B, native T1 before and after procedures was 1015 ms (970–1044) and 992 ms (867–1051), p=0.003, and ECV 27.5 (25.3–29.9) and 30.3 (26.5–34.3), p=0.02. The comparison of native T1 difference before and after procedures between groups A and B was not significant (Delta T1 −9.8 (−102 to 51.8) × −25.4 (−119 to 51,2), p=0.87. However, the difference of ECV between groups was statistically significant (ECV Delta 3.8 (2.2 to 7.1) × 1.3 (−1.1 to 4.9), p=0.039, respectively, for groups A and B. Figure 1 Conclusion In this sample, T1 mapping identified significant myocardial structural changes in both surgical revascularization procedures. Additionally, a marked myocardial injury generated by ECV changes were observed after on-pump CABG.

scholarly journals Predictors of Atrial Fibrillation following Coronary Artery Bypass Grafting

2011 ◽  
Vol 5 ◽  
pp. CMC.S7170 ◽  
Author(s):  
Feridoun Sabzi ◽  
Abdol Hamid Zokaei ◽  
Abdol Rasoul Moloudi
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Multivariate Logistic Regression Analysis ◽  
Categorical Variables ◽  
Group A ◽  
Group B

Background Atrial fibrillation (AF) is a frequent and serious complication of coronary artery bypass graft (CABG) surgery. Methods: We undertook a retrospective review of the records of patients undergoing CABG at Imam Ali Hospital between February 1, 2003 and February 1, 2006. The patients were divided in two groups, ie, Group A (AF) and Group B (no AF). The association between the occurrence of AF following CABG and other variables was compared with respect to continuous or categorical variables by t-test and χ2-test. Results Multivariate logistic regression analysis of potentially predictive factors in univariate analysis showed that opium use, type of operation, and crossclamp time were predictors of AF following CABG. Conclusion This study identifies some new predictors of postoperative AF, control of which could lead to a lower incidence of AF and reduced morbidity, mortality, and resource utilization for patients undergoing cardiac surgery.

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