Anesthesiological aspects of early activation of patients after aortocoronary bypass surgery

• Published in: Anesteziologiia i reanimatologiia no. 5; p. 13
• Main Authors: Iavorovskiĭ, A G, Trekova, N A, Guleshov, V A, Shabalkin, B V, Arzikulov, T S, Ziuliaeva, T P
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 01.09.2002
• Subjects: Aged; Anesthesia Recovery Period; Anesthesia, Epidural - methods; Anesthesia, General - methods; Anesthesia, Inhalation - methods; Anesthesia, Intravenous - methods; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Coronary Artery Bypass; Female; Hemodynamics - drug effects; Humans; Intubation, Intratracheal; Male; Middle Aged; Monitoring, Intraoperative; Myocardial Ischemia - surgery
• ISSN: 0201-7563

The specific features of the course of anesthesia and the time of extubation were studied in 142 patients suffering from coronary heart disease who had undergone myocardial revascularization. All the patients were divided into 3 groups in accordance with the type of anesthesia. Group 1 patients (n = 48) received routine anesthesia with ketamine, benzodiazepines, and large-dose fentanyl. Group 2 (n = 45) had combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics (such as isoflurane, diprivan, tracrium). In Group 3 (n = 49), the authors employed another developed modality of anesthesia using high thoracic (TII-TIV) epidural anesthesia as a basic component of anesthesiological maintenance. The two developed modalities of anesthesia almost halved the use of total dose opioids, which promoted patients' early postoperative recovery of consciousness and respiration. The time before extubation was 9.9 +/- 2.1, 4.5 +/- 1.1, and 1.5 +/- 1.2 hours in Groups 1, 2, and 3, respectively (p < 0.05). The developed anesthesia procedure using isoflurane, midazolam, propofol, and small-dose fentanyl ensures safe and early (up to 6-hour) extubation in 73% of the patients undergone aortocoronary bypass surgery. The developed anesthesiological protocol based on thoracic epidural anesthesia enables extubation to be carried out on the operating table within an hour in 75% of patients after aortocoronary bypass surgery. A comparative intraoperative analysis of hemodynamics, the incidence of myocardial ischemia, arrhythmias, glucose levels has indicated that the anesthesia techniques aimed at a patient's early activation are not inferior in the degree of protection to routine anesthesia using large doses of opioids, ketamine, and diazepam. When used in combination with thoracic epidural block, the methods are superior to the latter.