Comparison of influence of high thoracic epidural anesthesia and central analgesia on hemodynamic during on-bypass coronary artery bypass grafting

Objective. Despite some advantages, the use of high thoracic epidural anesthesia (HTEA) during cardiac operations may be discouraged by fear of adverse hemodynamic effects. Aim. To compare the hemodynamic effects of HTEA and central analgesia (CA) during on-bypass CABG. Methods. 132 patients were assigned into two groups – study group (n = 85), where the surgery was carried out under HTEA and control group (n = 47) - where the surgery was carried out under CA. Data of the intraoperative monitoring and trans-oesophageal cardiac ultrasound - cardiac index (CI), stroke index (SI), ejection fraction (EF) and index of systemic vascular resistance (ISVR) were obtained. Results. After induction and sternotomy patients in the study group had higher EF - 57(53, 65)% vs 54 ± 7% (p = 0,013) and 55 ± 8 vs 52 ± 9%, (p = 0,031). After sternotomy CI and SI in the study group were also higher, respectively 2,42 (2,0;3,1) vs 2,23±0,63 l · min-1 · m-2, (p = 0,041) and 43 (34;46) vs 37±10 ml · m-2 (p = 0.014). Conclusion. We concluded that HTEA has advantages over CA by its influence on hemodynamics