High thoracic epidural anesthesia in patients with synchronous carotid endarterectomy and off-pump coronary artery revascularization

Vojislava Čedomir Nešković; Predrag Milojević; Dragana Unić-Stojanović; Ivan Ilić; Zoran Slavković

doi:10.2298/2498

Vojislava Čedomir Nešković Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia
Predrag Milojević Dedinje Cardiovascular Institute, Belgrade, Serbia
Dragana Unić-Stojanović Dedinje Cardiovascular Institute, Belgrade, Serbia
Ivan Ilić Clinical Hospital Center Zemun, Belgrade, Serbia
Zoran Slavković Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

DOI: https://doi.org/10.2298/2498

Abstract

Background/Aim. In order to reduce the risk of cerebrovascular insults (CVI), the latest recommendations suggest that carotid endarterectomy (CEA) is strongly indicated in patients scheduled for coronary surgery when significant carotid artery stenosis is symptomatic and/or bilateral. The best results are obtained in small studies with CEA performed immediately prior to off-pump coronary bypass (OPCAB). We present 16 consecutive patients who underwent synchronous CEA and OPCAB under general anesthesia combined with high thoracic epidural anesthesia (TEA) in order to evaluate the safety and potential benefits of such anesthetic management. Methods. A total of 16 consecutive patients scheduled for simultaneous CEA and OPCAB with no contraindication for TEA were enrolled in the study. All the patients were anesthetized with TEA combined with general anesthesia. Early extubation was planed in all the patients for early assessment of neurological outcome. Demographics, comorbidity, quality of postoperative recovery, duration of mechanical ventilation, successful early extubation, outcome, length of Intensive Care Unit (ICU) and hospital stay were recorded. Results. Only two patients did not fulfill the criteria for early extubation. The average duration of mechanical ventilation for patients who fulfilled criteria for early extubation was 87.9 ± 85.0 (0–255) min. Five (31.25%) patients were extubated in the operating theater at the end of surgery. There were no deaths, nor neurological complications of TEA. Seven (43.7%) patients had at least one of the postoperative complications considered significant. None of them had CVI. None of the early extubated patients was reintubated or had postoperative respiratory failure. Conclusion. Our study revealed that a combination of general anesthesia with TEA appears to be good choice in synchronous CEA and OPCAB due to advantages of early extubation and early neurological assessment. Larger studies are necessary to determine real benefits on both short and long-term outcomes of such anesthetic management in synchronous CEA and OPCAB.

Key words:

endarterectomy, carotid; coronary artery bypass; comorbidity; anesthesia, epidural; postoperative complications.

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