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CARDIOVASCULAR ANESTHESIA

Thoracic Epidural Anesthesia for Cardiac Surgery: The Effects on Tracheal Intubation Time and Length of Hospital Stay

Mark C. Priestley, MBBS, FANZCA^*, Louise Cope, RN^*, Richard Halliwell, MBBS, FANZCA^*, Peter Gibson, MBBS, FANZCA^*, Richard B. Chard, MBBS, FRACS, Michael Skinner, MBBS, FRACP, and Peter L. Klineberg, MBBS, FANZCA^*

Departments of *Anaesthesia, Cardiothoracic Surgery, and Cardiology, Westmead Hospital, Westmead, Australia

Address correspondence and reprint requests to Mark Priestley, Department of Anaesthesia, Westmead Hospital, Westmead NSW 2145, Sydney, Australia.

Improvements in analgesia after major surgery may allow a more rapid recovery and shorter hospital stay. We performed a prospective randomized trial to study the effects of epidural analgesia on the length of hospital stay after coronary artery surgery. The anesthetic technique and postoperative mobilization were altered to facilitate early intensive care discharge and hospital discharge. Fifty patients received high (T1 to T4) thoracic epidural anesthesia (TEA) with ropivacaine 1% (4-mL bolus, 3–5 mL/h infusion), with fentanyl (100-µg bolus, 15–25 µg/h infusion) and a propofol infusion (6 mg · kg^-1 · h^-1). Another 50 patients (the General Anesthesia group) received fentanyl 15 µg/kg and propofol (5 mg · kg^-1 · h^-1), followed by IV morphine patient-controlled analgesia. The TEA group had lower visual analog scores with coughing postextubation (median, 0 vs 26 mm; P < 0.0001) and were extubated earlier (median hours [interquartile range], 3.2 [2.1–4.6] vs 6.7 [3.3–13.2]; P < 0.0001). More than half of all patients were discharged home on Postoperative Day 4 (24%) or 5 (33%), but there was no difference in the length of stay between the TEA group (median [interquartile range], Day 5 [5–6]) and the General Anesthesia group (median [interquartile range], Day 5 [4–7]). There were no differences in postoperative spirometry or chest radiograph changes or in markers for postoperative myocardial ischemia or infarction. No significant TEA-related complications occurred. In summary, TEA provided better analgesia and allowed earlier tracheal extubation but did not reduce the length of hospital stay after coronary artery surgery.

IMPLICATIONS: We found that epidural analgesia was more effective than IV morphine for cardiac surgery. Epidural anesthesia also allowed earlier weaning from mechanical ventilation, but it did not affect hospital discharge time.

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