PECULIARITIES OF HEMODYNAMIC CHANGES DURING HIGH THORACIC EPIDURAL ANESTHESIA IN BEATING HEART SURGERY

Aim: Myocardial protection during off-pump coronary artery bypass surgery is a multifactorial problem. Careful, individualized choice of graft sequence and maintenance of stable systemic hemodynamics are of central importance. Patients with coronary artery disease have a high risk of adverse cardiac outcome during and after surgery. Thoracic epidural anesthesia (TEA) aims at a more specific reversible blockade of cardiac sympathetic efferents provides effective intra- and postoperative analgesia.
Methods: 82 patients (mean age 69.2±14 years) undergoing off-pump coronary surgery have been divided into 2 groups (traditional general anesthesia (50), TEA combined anesthesia (32) (Naropin).
Results: In the TEA group heart rate (HR) was low (12.6%, p<0.05) compared with the group of traditional anesthesia during the construction of the anastomoses for any of the three surgical setting. Parameters of cardiac index had no difference between groups, but stroke index was higher (17.4%) in TEA group that specifies to more optimum work of heart at which the greatest duration of diastole is kept for improvement of the coronary blood flow. Myocardial oxygen consumption decreases due to decreased heart rate and low peripheral vascular resistance (11.8 %) and pulmonary vascular resistance (26.3%) in comparison with control group. Coronary perfusion pressure does not suffer in the setting of epidural blockade, no significant differences between groups were found in systemic arterial pressure.
Conclusion: TEA provides better hemodynamic control and analgesia compared with traditional anesthesia. Exposure and stabilization of the three main coronary arteries during beating heart surgery does not produce any appreciable change in the systemic blood pressure and heart rate.

Keywords
off-pump coronary surgery, high thoracic epidural anesthesia, hemodynamic changes.