Master of Science in Nursing (MSN)
Coronary artery bypass graft (CABG) surgery is the most common type of heart surgery in the United States. The main benefit of CABG surgery is a significant decrease in myocardial infarction rate, while the most common complications of CABG are myocardial damage and atrial fibrillation. The incorporation of epidural anesthesia occurred in order to decrease sympathetic nervous system response during CABG but has not been extensively studied. A systematic review was conducted to compare the cardiovascular outcomes of the addition of thoracic epidural anesthesia to the anesthetic plan versus general anesthesia as a solo technique during coronary artery bypass grafting surgery. The PubMed database was searched to identify randomized controlled trials in adult patients undergoing CABG with implementation of thoracic epidural anesthesia versus general anesthesia only. Seven studies involving 668 participants met the criteria. A previously published meta- analysis of randomized controlled trials was also included. The Preferred Reporting Items for Systematic Review (PRISMA) checklist was utilized to extrapolate and synthetize the data. The Critical Appraisal Sheet for Controlled Randomized Studies was adapted from the FRISBE tool in order to compare both within and across the studies. Two outcomes were measured: the degree of cardiac damage that was represented by troponin level and atrial fibrillation rate. The limited evidence suggested that thoracic epidural anesthesia does not provide cardioprotective benefits in adult patients undergoing CABG. The results of the study should be interpreted with caution due to the limited information available and heterogeneity of the studies. The question of whether thoracic epidural anesthesia provides cardioprotective functions requires further investigation. Taking into consideration the results of this study, it is not recommended to use the epidural anesthesia as an adjunct technique on the routine basis during CABG until more information is available.
Keker, Lana, "Comparison of Outcomes of Combined Thoracic Epidural Anesthesia with General Anesthesia Verus General Anesthesia During Coronary Artery Bypass Graft Surgery" (2016). Master's Theses, Dissertations, Graduate Research and Major Papers Overview. 172.
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