Myocardial, inflammatory, and stress responses in off-pump coronary artery bypass graft surgery with thoracic epidural anesthesia

M Caputo, H Alwair, CA Rogers, M Ginty, CR Monk, SJ Tomkins, A Mokhtari, G Angelini

Research output: Contribution to journalArticle (Academic Journal)peer-review

26 Citations (Scopus)

Abstract

OBJECTIVES: Epidural anesthesia has been suggested to exert a protective effect against the inflammatory and stress responses associated with surgery. The aim of this study was to evaluate the impact of thoracic epidural anesthesia on myocardial cell damage, inflammatory, and stress responses in patients undergoing off-pump coronary artery bypass graft (OPCABG) surgery. METHODS: Seventy-four patients (66 male [89%], mean age 65.2 years [SD 9.6]) undergoing OPCABG surgery were randomly assigned to receive either general anesthesia plus epidural (GAE [n = 36]) or general anesthesia only (GA [n = 38]). Troponin I, 8-isoprostane, cortisol, C3alpha, interleukin (IL)-6, IL-8, and IL-10 were measured preoperatively, at 30 minutes, and 4, 12, 24, and 48 hours postoperatively. RESULTS: Baseline characteristics were similar in the two groups. One patient died in the GAE group, but no other major postoperative complications were recorded in either group. The IL-6 and IL-8 levels were lower in the GAE group (ratio 0.83, 95% confidence interval: 0.68 to 1.02; p = 0.070) than in the GA group (ratio 0.90, 95% confidence interval: 0.78 to 1.02; p = 0.090). The difference in levels of IL-10 between the GAE and GA groups varied over time (p greater, similar 0.001). The C3alpha, troponin I, 8-isoprostane, and cortisol release was similar in the two groups throughout (p > or = 0.12). CONCLUSIONS: Thoracic epidural anesthesia does not provide any additional benefits in terms of reducing myocardial damage, inflammatory, and stress response compared with general anesthesia only in patients undergoing OPCABG surgery.
Translated title of the contributionMyocardial, inflammatory, and stress responses in off-pump coronary artery bypass graft surgery with thoracic epidural anesthesia
Original languageEnglish
Pages (from-to)1119 - 1126
Number of pages8
JournalAnnals of Thoracic Surgery
Volume87(4)
Publication statusPublished - Apr 2009

Structured keywords

  • BTC (Bristol Trials Centre)

Fingerprint Dive into the research topics of 'Myocardial, inflammatory, and stress responses in off-pump coronary artery bypass graft surgery with thoracic epidural anesthesia'. Together they form a unique fingerprint.

Cite this