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European Journal of Cardio-Thoracic Surgery, Vol 10, 859-865, Copyright © 1996 by European Association for Cardio-thoracic Surgery
R Stenseth, L Bjella, EM Berg, O Christensen, OW Levang and SE Gisvold
OBJECTIVE: A substantial reduction in lung volumes and pulmonary function
follows cardiac surgery. Pain may prevent effective breathing and coughing,
and as thoracic epidural analgesia may reduce postoperative pain, we
investigated the effect of epidural analgesia on pulmonary function.
METHODS: Fifty-four male patients, under 65 years and with an ejection
fraction of more than 0.5, were randomized into two groups: a control group
receiving high-dose fentanyl anaesthesia and an epidural group receiving
low-dose fentanyl anaesthesia + thoracic epidural analgesia. Time to
awakening and time to extubation were recorded. Further, spirometric data,
arterial oxygenation, pulmonary shunt, haemodynamics, use of vasoactive
drugs and fluid balance were followed for up to 6 days postoperatively.
RESULTS: Patients with low-dose fentanyl and epidural analgesia awoke (1.6
vs 3.6 h) and were extubated (5.4 vs 10.8 h) significantly earlier than
control group patients. A 50-70% reduction in forced vital capacity, forced
expiratory volume in 1 s (FEV1.0) and peak expiratory flow rate (PEFR) was
seen after surgery, but higher FEV1.0 and PEFR on days 2 and 3 were seen in
the epidural group than in the control group. Pulmonary shunt and
alveolo-arterial oxygen difference increased similarly in both groups,
whereas oxygen delivery and mixed venous oxygen saturation were higher in
the epidural group. Epidural analgesia gave better control of the
postoperative hyperdynamic circulation. CONCLUSIONS: Thoracic epidural
analgesia yields a slight, but significant, improvement in pulmonary
function, most likely due to a more profound postoperative analgesia.
ARTICLES
Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery
Department of Anesthesiology, Regional Hospital, University of Trondheim, Norway.
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