ANESTHESIA FOR CORONARY-ARTERY BYPASS-SURGERY SUPPLEMENTED WITH SUBARACHNOID BUPIVACAINE AND MORPHINE - A REPORT OF 18 CASES

We report our experience with general anaesthesia (GA) supplemented wi th subarachnoid bupivacaine and morphine for coronary artery bypass su rgery (CABG) in 18 patients. Fifteen patients were male, and mean age was 62 yr. Anaesthesia (GA) was induced with alfentanil 97 +/- 22 mu g .kg(-1) and midazolam 0.04 +/- 0.02 mg.kg(-1) supplemented with a musc le relaxant, and maintained with isoflurane (0.25-0.5%) in oxygen thro ughout surgery. Spinal anaesthesia (SA) was then performed at a lumber level using hyperbaric bupivacaine (23-30 mg) and/or lidocaine (150 m g) with morphine (0.5-1 mg) Pooled data showed the following haemodyna mic results (P < 0.05). Induction of GA produced a decrease in mean ar terial pressure (MAP). Addition of SA produced a decrease in heart rat e. Heart rate and MAP did not change with sternotomy. Phenylephrine su pport of arterial blood pressure was used at some time during operatio n in 17 patients. Supplementation of GA was minimal. Patients received 2.7 +/- 0.7 coronary grafts. Operating room time wars 3.9 +/- 0.6 hr. Postoperative analgesic requirements were minimal, and in half of the patients tracheal extubation occurred on the day of surgery. Complica tions included one myocardial infarction, one resternotomy, a metaboli c encephalopathy in a dialysis-dependent patient, and one case of herp es labialis. No patient recalled intraoperative events. Combined GA wi th SA may be an effective technique for CABG surgery. Further study of the cardiovascular, neurological and metabolic effects of the techniq ue is required.