THORACIC EPIDURAL-ANESTHESIA FOR CORONARY-ARTERY BYPASS GRAFT-SURGERY- EFFECTS ON POSTOPERATIVE COMPLICATIONS

We have performed a retrospective analysis of the peri-operative cours e of 218 consecutive patients who underwent routine coronary artery by pass graft surgery in this institution. All patients received a standa rdised general anaesthetic using target-controlled infusions of alfent anil and propofol. One hundred patients also received thoracic epidura l anaesthesia with bupivacaine and clonidine, started before surgery a nd continued for 5 days after surgery. The remaining 118 patients rece ived target-controlled infusion of alfentanil for analgesia for the fi rst 24 h after surgery, followed by intravenous patient-controlled mor phine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory neurological, renal , gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p = 0.02). There was also a tren d towards a reduced incidence of respiratory; complications in the tho racic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patie nts being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurologi cal problems resulting from the use of thoracic epidural analgesia.