анестезия в кардиохирургии

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Аспирант ----- Уважаемые коллеги! Предлагаю обсудить проблему применения эпидуральной анестезии при операциях на сердце. В частности ЭДА при шунтировании коронарных артерий без искусственного кровообращения. Известно, что на Западе выполняют также и спинальную анестезию морфином, а также суфентанилом при этих вмешательствах. Буду очень рад узнать ваше мнение.

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MD ----- Dear collegas! I think you confused. Epidural block sometime used for pain manegment after torakotomy. But not for anesthesia during surgery. Sufentanil very hard to titrate, so usually everybody prefere Fentanil. I dont think that Sufentanil have big future and Remifentanil too. MD

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M ----- : Ann Thorac Surg 2000 Jul;701:91-6 Related Articles, Books, LinkOut Coronary artery bypass grafting in the conscious patient without endotracheal general anesthesia. Karagoz HY, Sonmez B, Bakkaloglu B, Kurtoglu M, Erdinc M, Turkeli A, Bayazit K Department of Cardiovascular Surgery, Guven Hospital, Ankara, Turkey. <A HREF="mailto:[Ссылки доступны только зарегистрированным пользователям ].tr">[Ссылки доступны только зарегистрированным пользователям ].tr</A> BACKGROUND: Over the past several years, considerable experience has accumulated in performing coronary anastomoses on the beating heart, and various aspects of minimally invasive approaches have been simplified. In an attempt to further simplify and decrease the invasiveness of this procedure, performing this operation without endotracheal general anesthesia was deemed feasible in certain subsets of patients. METHODS: Between October 1998 and June 1999, 5 patients underwent coronary artery bypass grafting without endotracheal general anesthesia, using high thoracic epidural block to construct extension grafts with a short segment of radial artery, between the in situ left or right internal thoracic arteries and the left anterior descending n = 4 or right coronary arteries n = 1. There were 2 female and 3 male patients, with a mean age of 67.4 /- 8.3 years. RESULTS: The perioperative course of the patients was uneventful. There was no perioperative morbidity or mortality. No patient was converted to general anesthesia or to conventional operation. Control angiograms revealed patent anastomoses in all patients. In 1 patient, spasm of the radial artery graft was observed that was relieved 3 weeks later spontaneously. Mean length of hospital stay was 2.2 /- 0.4 days. All patients were symptom free and returned to normal daily life at the first postoperative month. CONCLUSIONS: Our initial experience confirms the feasibility of performing coronary bypass grafting in the conscious patient without endotracheal general anesthesia. Publication Types: Clinical trial PMID: 10921688, UI: 20377156

[Ivanov]

ЭА в КХ - методика перспективная и с использованием АИК. Более хлопотная, согласен. Менее понятная хирургам. Пользуется меньшим доверием у пациентов, поскольку поросла досужими слухами про страшный укол в спинной мозг. После серии успешных анестезий все становится на свои места.
Видимо, именно в КХ практике ЭА ставку следует делать не на современные местные анестетики, а на их разумное сочетание с наркотическими анальгетиками и клонидином.
Хотелось бы узнать Ваше мнение.