January 1, 1997Anesthesia & Analgesia

Thoracic Epidural Anesthesia as the Last Option for Treating Angina in a Patient Before Coronary Artery Bypass Surgery

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Why the study?

Does thoracic epidural anesthesia relieve medically refractory unstable angina and stabilize a high-risk patient for coronary artery bypass surgery?

Population

1 68-year-old man with ischemic cardiomyopathy, medically refractory unstable angina, poor ventricular…

Design

Case_report

Follow-up

Hospitalization period (discharged 8 days after surgery)

Authors

FOFrank J. OverdykColumbia University PGPatricia Gramling-BabbUniversity of Illinois Chicago JHJohn R. HandyProvidence St. Vincent Medical Center

Discussion

Member takes

Implication

May support thoracic epidural as last-resort bridge in refractory angina; single case leaves open need for prospective trials.

Structured PICO

Does thoracic epidural anesthesia relieve medically refractory unstable angina and stabilize a high-risk patient for coronary artery bypass surgery?

Population

1 68-year-old man with ischemic cardiomyopathy, medically refractory unstable angina, poor ventricular function (EF 20%), and complicated comorbidities (hypertension, peripheral vascular disease, prior CVA, pacemaker, acute tubular necrosis).

Intervention

Thoracic epidural anesthesia (TEA) initiated with a 5-mL bolus of 0.25% bupivacaine, followed by a continuous infusion of 0.0625% bupivacaine with 100 µg/mL of morphine at 4 mL/h, continued intraoperatively and postoperatively for CABG surgery.

Outcome

Relief of angina symptoms and hemodynamic stabilization prior to and during coronary artery bypass surgery.patient reported

Thoracic epidural anesthesia can serve as an effective last-resort therapy to relieve intractable angina and stabilize high-risk patients with ischemic cardiomyopathy prior to coronary artery bypass surgery.

Limitations

Single case report
Cannot definitively substantiate findings for continuous infusion versus bolus dosing

Cite This Study

Overdyk et al. (1997) studied this question.

synapsesocial.com/papers/6a83346fc4b5dbf8331f35d4 https://doi.org/10.1213/00000539-199701000-00038

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Thoracic Epidural Anesthesia as the Last Option for Treating Angina in a Patient Before Coronary Artery Bypass Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Thoracic Epidural Anesthesia as the Last Option for Treating Angina in a Patient Before Coronary Artery Bypass Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider