Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: General anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone

Objective: This study compared general anesthesia (GA), combined GA plus thoracic epidural anesthesia (TEA), and TEA alone in patients scheduled for off-pump coronary artery bypass grafting. Design: Prospective, nonrandomized clinical study Setting: University hospital. Participants: Ninety consenting patients undergoing beating-heart coronary artery revascularization with comparable coronary status and left ventricular function. Interventions: GA (n = 30) was conducted with propofol, remifentanil, and cisatracurium or combined with TEA (GA + TEA, n = 30) or TEA as the sole anesthetic with ropivacaine plus sufentanil (TEA, n = 30). Measurements and Main Results: Groups were comparable regarding the surgical approaches and the number of anastomoses. Four patients (GA, n = 2; GA + TEA, n = 2) who required unplanned cardiopulmonary bypass, and 4 patients in the TEA group who underwent unexpected intubation because of pneumothorax (n = 2), phrenic nerve palsy, or incomplete analgesia were excluded from further analysis. Intraoperative heart rate decreased significantly with both GA + TEA and TEA. None of the patients with TEA alone was admitted to the intensive care unit, they all were monitored on average for 6 hours postoperatively in the intermediate care unit and allowed to eat and drink as desired on admission. Postoperative pain scores were lower in both groups with TEA. There were no differences among groups in patients' overall satisfaction. Conclusion: Based on the authors' data, all anesthetic techniques were equally safe from the clinician's standpoint. However, GA + TEA appeared to be most comprehensive, allowing for revascularization of any coronary artery, providing good hemodynamic stability and reliable postoperative pain relief. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated. (C) 2005 Elsevier Inc. All rights reserved.