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Videosurgery and Other Miniinvasive Techniques
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2/2020
vol. 15
 
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abstract:
Original paper

Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery

Arkadiusz Kurowicki
1
,
Michal Borys
2
,
Slawomir Zurek
1
,
Beata Horeczy
3
,
Boguslaw Gaweda
1
,
Bartlomiej Belina
3
,
Bozena Trojnar
1
,
Bogumila Woloszczuk-Gebicka
4
,
Justyna Sejboth
5
,
Miroslaw Czuczwar
2
,
Kazimierz Widenka
1, 4

  1. Clinical Department of Cardiac Surgery, St. Jadwiga Provincial Clinical Hospital, Rzeszow, Poland
  2. 2nd Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
  3. Anesthesiology and Intensive Care Department with the Center for Acute Poisoning, St. Jadwiga Provincial Clinical Hospital, Rzeszow, Poland
  4. Medical College, Rzeszów University, Poland
  5. Department of Anaesthesiology and Intensive Care, Department of Clinical Anaesthesiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Videosurgery Miniinv 2020; 15 (2): 346–350
DOI: https://doi.org/10.5114/wiitm.2019.88748
Online publish date: 2019/10/15
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Introduction
Working on the institutional Enhanced Recovery After Surgery (ERAS Cardio) protocol for off-pump coronary artery bypass graft surgery (OP-CABG) we have noticed that patients treated according to the modified anesthesia protocol had not only significantly shorter time of respiratory support and intensive care unit stay but also lower postoperative troponin T concentration than patients who had standard fentanyl/sevoflurane-based anesthesia.

Aim
To compare the perioperative course of patients undergoing OP-CABG surgery and receiving standard fentanyl/sevoflurane anesthesia and those anesthetized according to the institutional ERAS Cardio protocol with remifentanil, sevoflurane, and bilateral extensor spinae plane (ESP) block.

Material and methods
Design: a prospective, open-label, observational study performed in a tertiary health center. Participants: 30 consecutive patients undergoing off-pump coronary bypass graft surgery. Interventions: 15 patients had standard anesthesia with etomidate, fentanyl, and rocuronium for induction and fentanyl/sevoflurane for maintenance (standard group); 15 others had bilateral single shot ESP block, then etomidate, remifentanil and rocuronium for induction, and remifentanil/sevoflurane for maintenance of anesthesia.

Results
Median time to extubation was 7.6 (5.5–12.5) h and 1.7 (1–3.25) h in “standard care” and ERAS groups, respectively (p = 0.00002). Length of stay in the intensive care unit was also shorter for patients in the ERAS group 20.5 (18–24) vs. 48 (42–48) h (p = 0.00001). Troponin concentration increased to a lesser extent in patients from the ERAS group: an increase of 151.8 (71.9–174.3) ng/ml vs. 253.8 (126.6–373.1) ng/ml, p = 0.008.

Conclusions
Remifentanil/sevoflurane anesthesia combined with bilateral ESP block shortens mechanical ventilation time and ICU stay, and decreases postoperative troponin-T concentration in patients undergoing off-pump coronary bypass graft surgery.

keywords:

fentanyl, remifentanil, troponin T, nerve block, coronary bypass grafting, off pump
  
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