The Efficiency of Epidural Anesthesia and Postoperative Analgesia during Myocardial Revascularization without Extracorporeal Circulation

Objective: to evaluate the efficiency of high thoracic epidural anesthesia (EA) and analgesia during aortocoronary bypass surgery (ACBS) without extracorporeal circulation (EC). Subjects and methods. The study enrolled 93 patients who had undergone ACBS without EC. The patients were randomized to three groups: 1) 30 controls who had balanced endotracheal anesthesia with propofol and fentanyl and postoperative intravenous analgesia with fentanyl; 2) 30 patients who received epidural infusion with combined endotracheal and epidural (0.75% ropivacaine, 10—12 ml, and fentanyl, 2—3 ^g/kg) anesthesia and postoperative infusion of 0.2% ropivacaine and fentanyl, 2 ^g/ml, into the epidural space at a rate of 3—10 ml/hr; 3) 30 patients who had epidural infusion with autoanalgesia in which autoanalgesia with ropivacaine and fentanyl were additionally used during their epidural infusion after ACBS. Results. The less severe degrees of arterial hypertension and myocardial depression were observed in the EA groups during ACBS (p<0.05). In these groups, the mean decreases in the intraoperative consumption of propofol, fentanyl, and nitroglycerol were 15%, 50%, and 7-fold, respectively. As compared with the controls, the frequency of the use of colloids and sympathomimetics showed at the same time 2- and 3-fold increases, respectively (p<0.05). In the postoperative period, arterial oxygenation was higher during epidural infusion with autoanalgesia and the value of lactate was higher in the control group (p<0.05). Epidural infusion ensured the maximum reduction in the magnitude of pain syndrome; there was a 46% drop in the time of postoperative mechanical ventilation in the epidural autoanalgesia group (p<0.05). Conclusion. During ACBS without ES, _ epidural anesthesia and analgesia provided hemodynamic stability and optimal postoperative analgesia. After ACBS, epidural infusion with autoanalgesia improves lung function and tissue perfusion and reduces the duration of respiratory support.