Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery: L'analgesie peridurale thoracique ameliore la fonction pulmonaire chez les patients subissant une chirurgie cardiaque Export

@article{citeulike:3044750, abstract = {Purpose: Pulmonary dysfunction commonly occurs following coronary artery bypass graft (CABG) surgery, increasing morbidity and mortality. We hypothesized that thoracic epidural anesthesia (TEA) would improve pulmonary function and would decrease complications in patients undergoing CABG surgery. Methods: This prospective, randomized, controlled trial was conducted with Ethics Board approval. Fifty patients, undergoing CABG surgery, were randomized to the epidural group or to the patient-controlled analgesia morphine group. Patients in the epidural group received a high, thoracic epidural, preoperatively. Intraoperatively, 0.75\% ropivacaine was infused, followed postoperatively, by 0.2\% ropivacaine for 48 hr. Outcome measurements included: visual analogue pain scores; spirometry; atelectasis scores on chest radiographs; and the incidence of atrial fibrillation. Results: Twenty-five patients were enrolled in each group. Patients in the epidural group had significantly less pain on the operative day, and for the subsequent two days. Compared to baseline, the forced expiratory volume in one second was significantly higher in the epidural group, on the first and second postoperative days (43.7 {+/-} 12.2\% vs 36.4 {+/-} 12.0\%, p < 0.002, and 43.3 {+/-} 12.5\% vs 38.4 {+/-} 11.0\%, p <0.05). There was significantly more atelectasis in the control group, four hours postoperatively (p < 0.04); however, on the third, postoperative day, the groups were similar with regards to this outcome. The incidence of atrial fibrillation was similar in both groups, and there were no complications related to the epidural. Conclusions: High TEA decreases postoperative pain and atelectasis and improves pulmonary function in patients undergoing CABG surgery. Our results support the use of TEA in this group of patients.}, author = {Tenenbein, Paul K. and Debrouwere, Roland and Maguire, Doug and Duke, Peter C. and Muirhead, Brian and Enns, James and Meyers, Michael and Wolfe, Kevin and Kowalski, Stephen E.}, citeulike-article-id = {3044750}, citeulike-linkout-0 = {http://www.cja-jca.org/cgi/content/abstract/55/6/344}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18566197}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18566197}, day = {1}, journal = {Can J Anesth}, keywords = {cardiac, epidural, june-08, surgery, thoracic}, month = {June}, number = {6}, pages = {344--350}, posted-at = {2008-07-26 15:34:45}, priority = {2}, title = {Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery: L'analgesie peridurale thoracique ameliore la fonction pulmonaire chez les patients subissant une chirurgie cardiaque}, url = {http://www.cja-jca.org/cgi/content/abstract/55/6/344}, volume = {55}, year = {2008} }

TY - JOUR ID - citeulike:3044750 L3 - citeulike-article-id:3044750 N2 - Purpose: Pulmonary dysfunction commonly occurs following coronary artery bypass graft (CABG) surgery, increasing morbidity and mortality. We hypothesized that thoracic epidural anesthesia (TEA) would improve pulmonary function and would decrease complications in patients undergoing CABG surgery. Methods: This prospective, randomized, controlled trial was conducted with Ethics Board approval. Fifty patients, undergoing CABG surgery, were randomized to the epidural group or to the patient-controlled analgesia morphine group. Patients in the epidural group received a high, thoracic epidural, preoperatively. Intraoperatively, 0.75% ropivacaine was infused, followed postoperatively, by 0.2% ropivacaine for 48 hr. Outcome measurements included: visual analogue pain scores; spirometry; atelectasis scores on chest radiographs; and the incidence of atrial fibrillation. Results: Twenty-five patients were enrolled in each group. Patients in the epidural group had significantly less pain on the operative day, and for the subsequent two days. Compared to baseline, the forced expiratory volume in one second was significantly higher in the epidural group, on the first and second postoperative days (43.7 {+/-} 12.2% vs 36.4 {+/-} 12.0%, p < 0.002, and 43.3 {+/-} 12.5% vs 38.4 {+/-} 11.0%, p <0.05). There was significantly more atelectasis in the control group, four hours postoperatively (p < 0.04); however, on the third, postoperative day, the groups were similar with regards to this outcome. The incidence of atrial fibrillation was similar in both groups, and there were no complications related to the epidural. Conclusions: High TEA decreases postoperative pain and atelectasis and improves pulmonary function in patients undergoing CABG surgery. Our results support the use of TEA in this group of patients. IS - 6 JF - Can J Anesth EP - 350 TI - Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery: L'analgesie peridurale thoracique ameliore la fonction pulmonaire chez les patients subissant une chirurgie cardiaque VL - 55 SP - 344 KW - cardiac KW - epidural KW - june-08 KW - surgery KW - thoracic AU - Tenenbein, Paul AU - Debrouwere, Roland AU - Maguire, Doug AU - Duke, Peter AU - Muirhead, Brian AU - Enns, James AU - Meyers, Michael AU - Wolfe, Kevin AU - Kowalski, Stephen PY - 2008/06/01/ UR - http://www.cja-jca.org/cgi/content/abstract/55/6/344 ER -