Benefits and Risks of Epidural Analgesia in Coronary Artery Bypass Graft Surgery

Mohamed Yahia Abdelraziq Saleh


Abstract


Coronary artery bypass graft surgery (CABG) is based on the principle that myocardial ischemia related to coronary artery obstructions can be corrected resulting in relief of the underlying ischemia. CABG is the most common procedure performed on the heart. Despite increasing competition from percutaneous intervention and other novel methods of non-surgical coronary revascularization, CABG remains one of the most definitive and durable treatments for severe coronary artery disease. The perioperative use of high thoracic epidural anaesthesia (TEA) as an adjunct to general anesthesia has been shown to be beneficial in patients with coronary artery disease. Superior pain control with TEA improves pulmonary function and reduces postoperative pulmonary dysfunction, allowing earlier extubation with less respiratory complications. Further advantages of TEA include T1–T5 sympatholysis with subsequent improvement of coronary and internal thoracic arterial perfusion, decreased heart rate,and potential reduction of arrhythmias. Conversely, in cardiac surgery, the use of epidurals have been tempered worldwide as a result of the fear that the risk of epidural hematoma might be higher than in other surgical settings, because of the full-dose anticoagulation required for cardiopulmonary bypass Conclusion:Epidural usage has shown superior analgesia with reduction in ventilation time and pulmonary complications. It is also associated with a reduced incidence of supraventricular tachycardia and less confusion. Ultimately, it improves overall quality of recovery and promotes earlier hospital discharge. Despite these potential advantages, however, in the setting of the risk of hematoma controversy, researchers have attempted to identify whether epidurals reduce mortality, in order to counterbalance the perceived risk of the technique. Keywords: Coronary artery bypass graft surgery, Epidural analgesia Shah D. (2010). Coronary Artery Bypass Graft Surgery (CABG): past present and future. Gujart Medical Journal, 44(7), 394–399. Dopfmer UR, Dopfmer S, Beck DH, et al.. (2002). Thoracic epidural analgesia increases vital capacity after cardiac surgery. Acta AnaesthesiolScand, 46(3), 338-339.


Other data

Other Titles فوائد وأضرار التسكين فوق الجافية في عملية ترقيع الشرايين التاجية
Issue Date 2017
URI http://research.asu.edu.eg/handle/12345678/2640


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