Thoracic epidural analgesia in aortocoronary bypass surgery II: effects on the endocrine metabolic response
| Autor: | Roar Stenseth, Olaf W. Levang, Lise Bjella, Einar M. Berg, O. Christensen, Sven Erik Gisvold |
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| Rok vydání: | 1994 |
| Předmět: |
Blood Glucose
Male Epinephrine Hydrocortisone Hemodynamics Coronary Disease Fatty Acids Nonesterified Fentanyl law.invention Norepinephrine law medicine Cardiopulmonary bypass Humans Endocrine system General anaesthesia Lactic Acid Coronary Artery Bypass business.industry General Medicine Middle Aged Bupivacaine Blockade Analgesia Epidural Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Anesthesia Intravenous Lactates Vascular resistance Vascular Resistance business medicine.drug Hormone |
| Zdroj: | Acta Anaesthesiologica Scandinavica. 38:834-839 |
| ISSN: | 1399-6576 0001-5172 |
| Popis: | Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may-in part-be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS). Thirty male patients (age65 years, ejection fraction0.5) were randomized into 3 groups; the HF group receiving a high dose fentanyl (55 micrograms.kg-1) anaesthesia, the HF+TEA group with the same fentanyl dose+TEA with 10 ml bupivacain 5 mg.ml-1, followed by 4 ml every hour, and the LF+TEA group receiving fentanyl 15 micrograms.kg-1 + TEA. Adrenalin, noradrenalin, systemic vascular resistance (SVR), glucose, cortisol, lactate and free fatty acids were followed during the operation and for 20 h postoperatively. A significant increase in adrenalin, noradrenalin and SVR was found in the HF group whereas this increase was blocked in both epidural groups. An increase in glucose and cortisol was noticed in all groups, but the increase was delayed in the epidural groups. Our results suggest that a more effective blockade of the stress response during ACBS is obtained when TEA is added to general anaesthesia than with high dose fentanyl anaesthesia alone. |
| Databáze: | OpenAIRE |
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