Next article Search Articles Instructions for authors  Access Statistics | Citation Manager  
ORIGINAL ARTICLE  

 Article Access Statistics
    Viewed1099    
    Printed12    
    Emailed0    
    PDF Downloaded111    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


Click on image for details.

 High thoracic epidural decreases perioperative myocardial ischemia and improves left ventricle function in aortic valve replacement alone or in addition to cabg surgery even with increased left ventricle mass index

Ahmed S Elgebaly1, Sameh M Fathy1, Yaser Elbarbary2, Ayman A Sallam3
1 Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
2 Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt
3 Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
Ahmed S Elgebaly
Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, 19 Elfaloga Street, Elgharbia, Tanta
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_203_18

Rights and Permissions

Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 154-160

 
SEARCH
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles

  Article in PDF (653 KB)
Email article
Print Article
Add to My List
Introduction: High thoracic epidural (HTE) may reduce perioperative tachyarrhythmias, respiratory complications and myocardial ischemia (MI) and it may increase coronary perfusion and myocardial oxygen balance through sympatholysis and pain control. The aim of this study is to investigate the benefit of HTE in patients undergoing aortic valve replacement (AVR) alone or in addition to coronary artery bypass graft (CABG). Methods: This prospective randomized controlled study was conducted on 80 patients (40 with increased left ventricular mass index (LVMI) and 40 with normal LVMI) who were equally randomised (n = 40) to receive either GA with HTE (HTE group) or GA alone (GA group). Heart rate (HR), mean arterial blood pressure (MAP) and the incidence of ischemic ECG changes were recorded. LV functions (preoperative and postoperative by transthoracic echocardiography and intraoperative by transoesophageal echocardiography) were measured preoperative, intraoperative and till 48 H postoperative. Results: There was no significant difference in the baseline values of all measurements. HR and MAP were lower, and LV functions were improved in HTE group intraoperatively and postoperatively. Ischemic ECG changes were significantly lower in HTE group; with 42.9% intraoperative risk reduction (95% CI: 0.195-0.943) and 46.6% postoperative risk reduction (95% CI 0.227-0.952) as compared to GA group. The risk of ischemia was significantly higher in patients with increased LVMI in GA group (2.25 times compared to normal LVMI patients with 95% CI: 1.195-4.236), but it wasn't increased in HTE group. LV functions were significantly improved from the induction to 48 H postoperative in HTE group as compared to GA group. Conclusion: HTE reduced the incidence of MI and improved the LV function, even with increased LVM, in patients undergoing AVR alone or in addition to CABG.






[FULL TEXT] [PDF]*
 

 

  Sitemap | Feedback | Disclaimer | What's New |  
  © Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
 Online since 5th January, 2008

 

 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 
 
 Reader Comments
 Email Alert *
  *
 * Requires registration (Free)
 
 ORIGINAL ARTICLE
 



Ahmed S Elgebaly1, Sameh M Fathy1, Yaser Elbarbary2, Ayman A Sallam3
1 Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
2 Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt
3 Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
Ahmed S Elgebaly
Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, 19 Elfaloga Street, Elgharbia, Tanta
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_203_18

Rights and Permissions

Introduction: High thoracic epidural (HTE) may reduce perioperative tachyarrhythmias, respiratory complications and myocardial ischemia (MI) and it may increase coronary perfusion and myocardial oxygen balance through sympatholysis and pain control. The aim of this study is to investigate the benefit of HTE in patients undergoing aortic valve replacement (AVR) alone or in addition to coronary artery bypass graft (CABG). Methods: This prospective randomized controlled study was conducted on 80 patients (40 with increased left ventricular mass index (LVMI) and 40 with normal LVMI) who were equally randomised (n = 40) to receive either GA with HTE (HTE group) or GA alone (GA group). Heart rate (HR), mean arterial blood pressure (MAP) and the incidence of ischemic ECG changes were recorded. LV functions (preoperative and postoperative by transthoracic echocardiography and intraoperative by transoesophageal echocardiography) were measured preoperative, intraoperative and till 48 H postoperative. Results: There was no significant difference in the baseline values of all measurements. HR and MAP were lower, and LV functions were improved in HTE group intraoperatively and postoperatively. Ischemic ECG changes were significantly lower in HTE group; with 42.9% intraoperative risk reduction (95% CI: 0.195-0.943) and 46.6% postoperative risk reduction (95% CI 0.227-0.952) as compared to GA group. The risk of ischemia was significantly higher in patients with increased LVMI in GA group (2.25 times compared to normal LVMI patients with 95% CI: 1.195-4.236), but it wasn't increased in HTE group. LV functions were significantly improved from the induction to 48 H postoperative in HTE group as compared to GA group. Conclusion: HTE reduced the incidence of MI and improved the LV function, even with increased LVM, in patients undergoing AVR alone or in addition to CABG.






[FULL TEXT] [PDF]*


        
Print this article     Email this article  

  Sitemap | Feedback | Disclaimer | What's New |  
  © Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
 Online since 5th January, 2008