Influence of inhalation and epidural anesthesia on complications after coronary artery bypass grafting
Background. Despite successful development of cardioanaesthesiology, there is currently no consensus on preferred technique for anesthetic management in coronary artery bypass grafting (CABG). Objective - to compare inhalation and thoracic epidural anaesthesia effects on postoperative complications during CABG. Material and methods. Authors performed retrospective study of 389 patients case histories, who were operated in the Cardiac Surgery Center of the State Medical Hospital No. 2 for 2017-2018. Patients were divided into two comparable groups by the type of anaesthesia performed. Evaluated indicators: preload, hydrobalance, dosage of catecholamine support, level of troponin I and natriuretic peptide type-B (BNP), Nursing Delirium screening Scale and Self Administrated Gerocognitive Exam (SAGE) scores. Frequency of postoperative complications and length of hospital stay were analyzed. Results. Inotropic support in inhalation anesthesia group was performed less often than in group with epidural anesthesia (99.5% and 83.0%, respectively p <0.01). An increase in the level of troponin I and BNP does not depend on the type of anaesthesia (1500 and 1600 pg/ml, 295 and 306 pg/ml, respectively, p>0.05). We observed marked decrease in cognitive function in the group of inhalation anaesthesia during operations under cardiopulmonary bypass 19.5 (17; 21) and 16.0 (14; 20) points on the SAGE scale, respectively ( p <0.05). Conclusion. Outcomes of surgical intervention did not depend on the type of anaesthesia. Both methods of anesthetic management can be successfully used in coronary artery bypass surgery. Epidural anesthesia has a lesser effect on development of disorders of higher mental functions in patients in the postoperative period who underwent CABG in conditions of cardiopulmonary bypass.