Применение эпидуральной анестезии в коронарной хирургии: за и против
#2020-2
PDF_2020-02_86-95
HTML_2020-02_86-95

Ключевые слова

кардиохирургия
высокая торакальная эпидуральная анестезия
кардиоанестезиология

Как цитировать

Волков Д.А., Паромов К.В., Еремеев А.В., Киров М.Ю. Применение эпидуральной анестезии в коронарной хирургии: за и против. Вестник интенсивной терапии имени А.И. Салтанова. 2020;(2):86–95. doi:10.21320/1818-474X-2020-2-86-95.

Статистика

Просмотров аннотации: 60
PDF_2020-02_86-95 загрузок: 19
HTML_2020-02_86-95 загрузок: 68
Статистика с 21.01.2023

Аннотация

Сердечно-сосудистая патология на протяжении многих лет сохраняет лидирующую позицию среди причин смерти в мире. Ведущей кардиальной патологией является ишемическая болезнь сердца, течение которой обусловлено преимущественно характером и степенью выраженности стенозирующего атеросклероза коронарного русла. Одним из хирургических способов восстановления проходимости артериального русла является аортокоронарное шунтирование. Периоперационный период коронарного шунтирования может сопровождаться респираторными осложнениями, развитием сердечной недостаточности, нарушений ритма и проводимости, почечной дисфункции и другими проблемами. Высокая эпидуральная анестезия и анальгезия за счет десимпатизации дерматомов, ассоциированных с иннервацией сердца, не только уменьшает периоперационный стресс и снижает выраженность болевого синдрома, вызванного стернотомией, но и обладает протекцией в отношении функции систем дыхания и кровообращения. Эти эффекты подтверждаются целым рядом исследований и систематических обзоров. Тем не менее рутинное использование нейроаксиальных блокад в кардиохирургии может быть ограничено повышением риска эпидуральных гематом и неврологических последствий. В обзоре приведены данные, посвященные физиологическому влиянию эпидуральной анестезии на сердце и клиническим аспектам ее применения в коронарной хирургии.
https://doi.org/10.21320/1818-474X-2020-2-86-95
PDF_2020-02_86-95
HTML_2020-02_86-95

Библиографические ссылки

  1. Melly L., Torregrossa G., Lee T., et al. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018; 10(3): 1960–1967. DOI: 10.21037/jtd.2018.02.43
  2. Head S.J., Milojevic M., Taggar D.P., Puskas J.D. Current practice of state-of-the-art surgical coronary revascularization. Circulation. 2017; 136(14): 1331–1345. DOI: 10.1161/circulationaha.116.022572
  3. Moazzami K., Dolmatova E., Maher J., et al. In-hospital outcomes and complications of coronary artery bypass grafting in the United States between 2008 and 2012. J Cardiothorac Vasc Anesth. 2017; 31(1): 19–25. DOI: 10.1053/j.jvca.2016.08.008
  4. Finnerty C.C., Mabvuure N.T., Ali A., et al. The surgically induced stress response. J Parenter Enteral Nutr. 2013; 37(5_suppl): 21–29. DOI: 10.1177/0148607113496117
  5. Baxter R., Squiers J., Conner W., et al. Enhanced recovery after surgery: a narrative review of its application in cardiac surgery. Ann Thorac Surg. 2019; 109: 1937–1944. DOI: 10.1016/j.athoracsur.2019.11.008109
  6. Noss C., Prusinkiewicz C., Nelson G., et al. Enhanced recovery for cardiac surgery. J Cardiothoracic Vasc Anesth. 2018; 32(6): 2760–2770. DOI: 10.1053/j.jvca.2018.01.045
  7. Klabunde R. Cardiovascular Physiology Concepts. Philadelphia, PA: Lippincott Williams & Wilkins/Wolters Kluwer; 2012.
  8. Takeshima R., Dohi S. Circulatory responses to baroreflexes, Valsalva maneuver, coughing, swallowing, and nasal stimulation during acute cardiac sympathectomy by epidural blockade in awake humans. Anesthesiology. 1985; 63(5): 500–508. DOI: 10.1097/00000542-198511000-00005
  9. Goertz A., Heinrich H., Seeling W. Baroreflex control of heart rate during high thoracic epidural anaesthesia a randomised clinical trial on anaesthetised humans. Anaesthesia. 1992; 47(11): 984–987. DOI: 10.1111/j.1365-2044.1992.tb03206.x
  10. Licker M., Spiliopoulos A., Tschopp J. Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery. Br J Anaesth. 2003; 91(4): 525–531. DOI: 10.1093/bja/aeg212
  11. Dohi S., Tsuchida H., Mayumi T. Baroreflex Control of heart rate during cardiac sympathectomy by epidural anesthesia in lightly anesthetized humans. Anesth Analg. 1983; 62(9): 15–20.
  12. Bonnet F., Szekely B., Abhay K., et al. Baroreceptor control after cervical epidural anesthesia in patients undergoing carotid artery surgery. J Cardiothoracic Anesth. 1989; 3(4): 418–424. DOI: 10.1016/s0888-6296(89)97411-5
  13. Kock M., Blomberg S., Emanuelsson H., et al. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Anesth Analg. 1990; 71(6): 625–630. DOI: 10.1213/00000539-199012000-00009
  14. Berendes E., Schmidt C., Van Aken H., et al. Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: a randomized trial. Arch Surg. 2003; 138(12): 1283–1290. DOI: 10.1001/archsurg.138.12.1283
  15. Jakobsen C.J., Nygaard E., Norrild K., et al. High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart. Acta Anaesthesiol Scand. 2009; 53(5): 559–564. DOI: 10.1111/j.1399-6576.2009.01939.x
  16. Jakobsen C.J., Bhavsar R., Nielsen D.V., et al. High thoracic epidural analgesia in cardiac surgery: part 1 — high thoracic epidural analgesia improves cardiac performance in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2012; 26(6): 1039–1047. DOI: 10.1053/j.jvca.2012.05.007
  17. Вотяков А.Л., Затевахина М.В., Суханов С.Г. Высокая грудная эпидуральная анестезия как основа периоперационного обеспечения безопасности реваскуляризации миокарда на работающем сердце. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2007; 8(1): 53–58. [Votjakov A.L., Zatevahina M.V., Suhanov S.G. Vysokaja grudnaja jepiduralʼnaja anestezija kak osnova perioperacionnogo obespechenija bezopasnosti revaskuljarizacii miokarda na rabotajushhem serdce. Bjulletenʼ NCSSH im. A.N. Bakuleva RAMN. 2007; 8(1): 53–58. (In Russ)]
  18. Schmidt C., Hinder F., Van Aken H., et al. The effect of high thoracic epidural anesthesia on systolic and diastolic left ventricular function in patients with coronary artery disease. Anesth Analg. 2005; 100(6): 1561–1569. DOI: 10.1213/01.ANE.0000154963.29271.36
  19. Ahmed W.G., Al-Afify A.A., Abu-Elnasr N.E.N., et al. Effect of high thoracic epidural analgesia on left ventricular function in patients with coronary artery disease undergoing elective non-cardiac surgery. Research Journal of Cardiology. 2011; 4(1): 28–37. DOI: 10.3923/rjc.2011.28.37
  20. Колеватова Л.А., Корниенко А.Н., Кецкало М.В. Влияние высокой эпидуральной блокады на функцию миокарда левого желудочка после аортокоронарного шунтирования. Общая реаниматология. 2006; 2: 54–58. DOI: 10.15360/1813-9779-2006-1-54-58. [Kolevatova L.A., Korniyenko A.N., Ketskalo M.V. Impact of High Epidural Block on Left Ventricular Myocardial Function After Aortocoronary Bypass Surgery. Obshhaja Reanimatologija. 2006; 2:54–58. (In Russ)]
  21. Goertz A.W., Seelingh W., Heinrichk H., et al. Influence of high thoracic epidural anesthesia on left ventricular contractility assessed using the end-systolic pressure-length relationship. Acta Anaesthesiol Scand. 1993; 37(1): 38–44. DOI: 10.1111/j.1399-6576.1993.tb03595.x
  22. Wattwila M., Sundberag A., Arvillan A., et al. Circulatory changes during high thoracic epidural anaesthesia — influence of sympathetic block and of systemic effect of the local anesthetic. Acta Anaesthesiol Scand. 1985; 29(8): 849–855. DOI: 10.1111/j.1399-6576.1985.tb02309.x
  23. Shiga T.J. Thoracic epidural blockade preserves left ventricular early diastolic filling assessed by transesophageal echocardiography. J Anesthesia. 1998; 12(1): 7–12. DOI: 10.1007/bf02480758
  24. Rex S., Missant C., Segers P., et al. Thoracic epidural anesthesia impairs the hemodynamic response to acute pulmonary hypertension by deteriorating right ventricular–pulmonary arterial coupling. Crit Care Med. 2007; 35(1): 222–229. DOI: 10.1097/01.ccm.0000250357.35250.a2
  25. Missant C., Claus P., Rex S., et al. Differential effects of lumbar and thoracic epidural anaesthesia on the haemodynamic response to acute right ventricular pressure overload. Br J Anaesth. 2010; 104(2): 143–149. DOI: 10.1093/bja/aep354
  26. Missant C., Rex S., Claus P., et al. Thoracic epidural anaesthesia disrupts the protective mechanism of homeometric autoregulation during right ventricular pressure overload by cardiac sympathetic blockade: a randomised controlled animal study. Eur J Anaesthesiol. 2011; 28(7): 535–543. DOI: 10.1097/eja.0b013e328346adf3
  27. Wink J., Veering B.T., Aarts L.P., et al. Effect of increasing age on the haemodynamic response to thoracic epidural anaesthesia. Eur J Anaesthesiol. 2014; 31(11): 597–605. DOI: 10.1097/EJA.0000000000000125
  28. Wink J., Wilde R.B., Patrick F., et al. Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling. Circulation. 2016; 134(16): 1163–1175. DOI: 10.1161/CIRCULATIONAHA.116.022415
  29. Lundberbg J., Biber B.A., Henrikssojn B.A., et al. Effects of thoracic epidural anesthesia and adrenoceptor blockade on the cardiovascular response to dopamine in the dog. Acta Anaesthesiol Scand. 1991; 35(4): 359–365. DOI: 10.1111/j.1399-6576.1991.tb03306.x
  30. Shibata K., Yamamoto Y., Murakami S. Effects of epidural anesthesia on cardiovascular response and survival in experimental hemorrhagic shock in dogs. Anesthesiology. 1989; 71(6): 953–959. DOI: 10.1097/00000542-198912000-00020
  31. Greitz T., Andreen M., Irestedt L. Haemodynamics and oxygen consumption in the dog during high epidural block with special reference to the splanchnic region. Acta Anaesthesiol Scand. 1983; 27(3): 211–217. DOI: 10.1111/j.1399-6576.1983.tb01937.x
  32. Fillinger M.P., Yeager M.P., Dodds T.M., et al. Epidural anesthesia and analgesia: effects on recovery from cardiac surgery. J Cardiothorac Vasc Anesth. 2002; 16(1): 15–20. DOI: 10.1053/jcan.2002.29639
  33. Liem T.H., Booij L.H., Hasenbos M.A., et al. Coronary artery bypass grafting using two different anesthetic techniques: Part I: Hemodynamic results. J Cardiothorac Vasc Anesth. 2002; 6(2): 148–155. DOI: 10.1016/1053–0770(92)90189-e
  34. Еремеев А.В., Сметкин А.А., Киров М.Ю. Эффективность эпидуральной анестезии и послеоперационной анальгезии при реваскуляризации миокарда без искусственного кровообращения. Общая реаниматология. 2010; 6:45–52. DOI: 10.15360/1813-9779-2010-6-45. [Yeremeyev A.V., Smetkin A.A., Kirov M.Y. The efficiency of epidural anesthesia and postoperative analgesia during myocardial revascularization without extracorporeal circulation. Obshhaja Reanimatologija. 2010; 6: 45–52. (In Russ)]
  35. Klassen G.A., Bramwell R.S., Bromage P.R., et al. Effect of acute sympathectomy by epidural anesthesia on the canine coronary circulation. Anesthesiology. 1980; 52(1): 8–15. DOI: 10.1097/00000542-198001000-00003
  36. Davis R.F., DeBoer L.W., Maroko P.R. Thoracic epidural anesthesia reduces myocardial infarct size after coronary artery occlusion in dogs. Anesth Analg. 1986; 65(7): 711–717.
  37. Mergner G.W., Stoke A.L., Frame W.B., et al. Combined epidural analgesia and general anesthesia induce ischemia distal to a severe coronary artery stenosis in swine. Anesth Analg. 1994: 78(1): 37–45. DOI: 10.1213/00000539-199401000-00008
  38. Hirabayashi Y., Shimizu R., Fukuda H., et al. Effects of thoracic vs. lumbar epidural anaesthesia on systemic haemodynamics and coronary circulation in sevoflurane anaesthetized dogs. Acta Anaesthesiol Scand. 1996; 40(9): 1127–1113. DOI: 10.1111/j.1399-6576.1996.tb05575.x
  39. Groban L., Zvara D.A., Deal D.D., et al. Thoracic epidural anesthesia reduces infarct size in a canine model of myocardial ischemia and reperfusion injury results. J Cardiothorac Vasc Anesth. 1999; 13(5): 579–585. DOI: 10.1016/s1053-0770(99)90011-3
  40. Stenseth R., Berg E.M., Bjella L., et al. Effects of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 1995; 9(5): 503–509. DOI: 10.1016/s1053-0770(05)80131-4
  41. Waurick R., Van Aken H. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol. 2005; 19(2): 201–213. DOI: 1016/j.bpa.2004.12.001
  42. Bulte C.S., Boer C., Hartemink K.J., et al. Myocardial microvascular responsiveness during acute cardiac sympathectomy induced by thoracic epidural anesthesia. J Cardiothorac Vasc Anesth. 2017; 31(1): 134–141. DOI: 10.1053/j.jvca.2016.05.039
  43. Nygård E., Kofoed K.F., Freiberg J., et al. Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease. Circulation. 2005; 111(17): 2165–2170. DOI: 10.1161/01.cir.0000163551.33812.1a
  44. Lagunilla J., García-Bengochea J.B., Fernández A.L., et al. High thoracic epidural blockade increases myocardial oxygen availability in coronary surgery patients. Acta Anaesthesiol Scand. 2006; 50(7): 780–786. DOI: 10.1111/j.1399-6576.2006.01059.x
  45. García-Delgado M., Navarrete-Sánchez I., Colmenero M. Preventing and managing perioperative pulmonary complications following cardiac surgery. Curr Opin Anesthesiol. 2014; 27(2): 146–152. DOI: 10.1097/aco.0000000000000059.
  46. Ball L., Costantino F., Pelosi P. Postoperative complications of patients undergoing cardiac surgery. Curr Opin Crit Care 2016; 22(4): 386–392. DOI: 10.1097/mcc.0000000000000319
  47. Gallart L., Canet J. Post-operative pulmonary complications: Understanding definitions and risk assessment anaesthesia. Best Pract Res Clin Anaesthesiol. 2015; 29(3): 315–330. DOI: 10.1016/j.bpa.2015.10.004
  48. Tenling A., Joachimsson P.O., Tydén H., et al. Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery. Effects on pulmonary mechanics. Acta Anaesthesiol Scand. 2000; 44(9): 1071–1076. DOI: 10.1034/j.1399-6576.2000.440906.x.
  49. Groeben H. Epidural anesthesia and pulmonary function. J Anesth. 2006; 20(4): 290–299. DOI: 10.1007/s00540-006-0425-6
  50. Lenkutis T., Benetis R., Sirvinskas E., et al. Effects of epidural anesthesia on intrathoracic blood volume and extravascular lung water during on-pump cardiac surgery. Perfusion. 2009; 24(4): 243–248. DOI: 10.1177/0267659109348724.
  51. Tenenbein P.K., Debrouwere R., Maguire D., et al. Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anesth. 2008; 55(6): 344–350. DOI: 10.1007/bf03021489.
  52. Liu S.S., Block B.M., Wu C.L. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery a meta-analysis. Anesthesiology. 2004; 101(1): 153–161. DOI: 10.1097/00000542-200407000-00024
  53. Kirov M.Y., Eremeev A.V., Smetkin A.A., et al. Epidural anesthesia and postoperative analgesia with ropivacaine and fentanyl in off-pump coronary artery bypass grafting: a randomized, controlled study. BMC Anesthesiol. 2011; 11(17). DOI: 10.1186/1471-2253-11-17
  54. Guay J., Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database of Syst Rev. 2019; 3. DOI: 10.1002/14651858.cd006715
  55. Priebe H.J. Perioperative myocardial infarction-aetiology and prevention. Br J Anesth. 2005; 95(1): 3–19. DOI: 10.1093/bja/aei063
  56. Liu S., Block B.M., Wu C.L. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery a meta-analysis. Anesthesiology. 2004; 101(1): 153–161. DOI: 10.1097/00000542-200407000-00024
  57. Möllhoff T., Theilmeier G., Van Aken H. Regional anaesthesia in patients at coronary risk for noncardiac and cardiac surgery. Curr Opin Anaesthesiol. 2001; 14(1): 17–25. DOI: 10.1097/00001503-200102000-00004
  58. Loick H.M., Schmidt C., Van Aken H., et al. High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatolysis and reduces the release of troponine Т in patients undergoing coronary artery bypass grafting. Anesth Analg. 1999:88(4): 701–709. DOI: 10.1097/00000539-199904000-00001
  59. Salvi L., Parolari A., Veglia F., et al. High thoracic Epidural anesthesia in coronary artery bypass surgery: a propensity-matched study. J Cardiothorac Vasc Anesth. 2007; 21(6): 810–815. DOI: 10.1053/j.jvca.2006.11.012
  60. Kendall J.B., Russell G.N., Scawn N.D., et al. A prospective, randomised, single-blind pilot study to determine the effect of anaesthetic technique on troponin T release after off-pump coronary artery surgery. Anaesthesia. 2004; 59(6): 545–549. DOI: 10.1111/j.1365-2044.2004.03713.x
  61. Barrington M.J., Kluger R., Watson R., et al. Epidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage. Anesth Analg. 2005; 100: 921–928. DOI: 10.1213/01.ane.0000146437.88485.47
  62. Caputo M., Alwair H., Rogers C.A., et al. Myocardial, inflammatory, and stress responses in off-pump coronary artery bypass graft surgery with thoracic epidural anesthesia. Ann Thorac Surg. 2009; 87(4): 1119–1126. DOI: 10.1016/j.athoracsur.2008.12.047
  63. Svircevic V., Nierich A.P., Moons K.G., et al. Thoracic epidural anesthesia for cardiac surgery: a randomized trial. Anesthesiology. 2011; 114(2): 262–270. DOI: 10.1097/aln.0b013e318201d2de
  64. Bignami E., Landoni G., Biondi-Zoccai G.G., et al. Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2010; 24(4): 586–597. DOI: 10.1053/j.jvca.2009.09.015
  65. Svircevic V., van Dijk D., Nierich A.P., et al. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011; 114(2): 271–282. DOI: 10.1097/aln.0b013e318201d300
  66. Echahidi N., Pibarot P., OʼHara G., et al. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008; 51(8): 793–801. DOI: 10.1016/j.jacc.2007.10.043
  67. de Oliveira R.M., Tenório S.B., Tanaka P.P., et al. Control of pain trough epidural block and incidence of cardiac dysrhythmias in postoperative period of thoracic and major abdominal surgical procedures: a comparative study. Rev Bras Anesthesiol. 2012; 62(1): 10–18. DOI: 10.1016/S0034–7094(12)70098–3
  68. Barbosa F.T., da Cunha R.M., da Silva Ramos F.W., et al. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis. Rev Bras Anesthesiol. 2016; 66(2): 183–193. DOI: 10.1016/j.bjane.2014.05.012
  69. Ho K.M., Bham E., Pavey W. Incidence of venous thromboembolism and benefits and risks of thromboprophylaxis after cardiac surgery: a systematic seview and meta-analysis. J Am Heart Assoc. 2015; 4(10): e002652. DOI: 10.1161/jaha.115.002652
  70. Zawar B.P., Mehta Y., Juneja R., et al. Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off-pump coronary artery bypass patients. Ann Card Anaesth. 2015; 18(3): 385–391. DOI: 10.4103/0971-9784.159810
  71. Tuman K.J., McCarthy R.J., March R.J., et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 1991; 73(6): 696–704. DOI: 10.1213/00000539-199112000-00005
  72. Obersztyn M., Trejnowska E., Nadziakiewicz P., et al. Evaluation of thoracic epidural analgesia in patients undergoing coronary artery bypass surgery — a prospective randomized trial. Kardiochir Torakochirurgia Pol. 2018; 15(2): 72–78. DOI: 10.5114/kitp.2018.76471
  73. Rodgers A., Walker N., Schug S., et al. Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia: results from overview of randomized trials. Br J Anesth. 2000; 321(7275): 1493. DOI: 10.1136/bmj.321.7275.1493
  74. Çelik B.B., Kudsioğlu K., Tandoğar N. The effects of thoracic epidural analgesia on postoperative pain and myocardial protection in coronary artery bypass surgery. Haseki Tip Bulleteni. 2015; 53(1): 72–76. DOI: 10.4274/haseki.2163
  75. Nesković V., Milojević P., Unić-Stojanović D., et al. Blood transfusion in cardiac surgery — does the choice of anesthesia or type of surgery matter? Vojnosanitet pregl. 2013; 70(5): 439–444.
  76. Palomero Rodríguez M.A., Suarez Gonzalo L., Villar Alvarez F., et al. Thoracic epidural anesthesia decreases C-reactive protein levels in patients undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass. Minerva Anestesiol. 2008; 74(11): 619–626.
  77. Gurses E., Berk D., Sungurtekin H., et al. Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery. Med Sci Monit. 2013; 19: 222–229. DOI: 10.12659/msm.883861
  78. Jakobsen C.J. High thoracic epidural in cardiac anesthesia. Semin Cardiothorac Vasc Anesthesia. 2015; 19(1): 38–48. DOI: 10.1097/aln.0b013e318201d2de
  79. Cheng D.C., Karski J., Peniston C., et al. Early tracheal extubation after coronary bypass graft surgery reduces costs and improves resource use: a prospective, randomized, controlled trial. Anesthesiology. 1996; 85(6): 1300–1310.
  80. Bignami E., Castella A., Pota V., et al. Perioperative pain management in cardiac surgery: a systematic review. Minerva Anestesiol. 2018; 84(4): 488–503. DOI: 10.23736/S0375-9393.17.12142-5
  81. Caputo M., Alwair H., Rogers C.A., et al. Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery. Anesthesiology 2011; 114(2): 380–390. DOI: 10.23736/S0375-9393.17.12142-5
  82. Li Y., Dong H., Tan S., et al. Effects of thoracic epidural anesthesia/analgesia on the stress response, pain relief, hospital stay, and treatment costs of patients with esophageal carcinoma undergoing thoracic surgery A single-center, randomized controlled trial. Medicine. 2019; 98(7): 14362. DOI: 10.1097/md.0000000000014362
  83. Zhang S., Wu X., Guo H., Ma L. Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials. Eur J Med Res. 2015; 20: 25. DOI: 10.1186/s40001-015-0091-y
  84. Bos E.M.E., Haumann J., de Quelerij M., et al. Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases. Br J Anaesth. 2018; 120(4): 693–704. DOI: 10.1016/j.bja.2017.11.105
  85. Hemmerling T.M., Cyr S., Terrasini N. Epidural catheterization in cardiac surgery: The 2012 risk assessment. Ann Card Anaesth. 2013; 16(3): 169–177. DOI: 10.4103/0971-9784.114237
  86. Horlocker T.T., Vandermeuelen E., Kopp S.L., et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fourth edition). Reg Anesth Pain Med. 2018. 43(3): 263–309. DOI: 10.1097/AAP.0000000000000763
  87. Pastor M.C., Sánchez M.J., Casas M.A., Mateu J., Bataller M.L. Thoracic epidural analgesia in coronary artery bypass graft surgery: seven yearsʼ experience. J Cardiothorac Vasc Anesth. 2003; 17(2): 154–159.
  88. Еременко A.A., Зюляева Т.П., Шандрук И.Д. и др. Постоянная эпидуральная инфузия ропивакаина гидрохлорида (наропина) при операционном обезболивании кардиохирургических больных. Анест. и реанимат. 2003; 5:63–67. [Eremenko A.A., Zyulyaeva T.P., Shandruk I.D., et al. Postoyannaya epiduralʼnaya infuziya ropivakaina gidrohlorida (naropina) pri operacionnom obezbolivanii kardiohirurgicheskih bolʼnyh. Anest. i reanimat. 2003; 5: 63–67. (In Russ)]
  89. Клыпа Т.В., Вершута Д.В., Степанова О.В., Козлов И.А. Первый опыт высокой эпидуральной анестезии наропином в комбинации с различными общими анестетиками во время операций с искусственным кровообращением. Регионарная анестезия и лечение боли: Тематический сборник. 2004: 280. [Klypa T.V., Vershuta D.V., Stepanova O.V., Kozlov I.A. Pervyj opyt vysokoj epiduralʼnoj anestezii naropinom v kombinacii s razlichnymi obshchimi anestetikami vo vremya operacij s iskusstvennym krovoobrashcheniem. Regionarnaya anesteziya i lechenie boli: Tematicheskij sbornik. 2004: 280. (In Russ)]
  90. Баялиева А.Ж., Торшин С.В., Лепилин П.М. Особенности анестезиологического обеспечения операций на работающем сердце. Клиническая физиология кровообращения. 2005; 3: 18–23. [Bayalieva A.Z., Torshin S.V., Lepilin P.M. Osobennosti anesteziologicheskogo obespecheniya operacij na rabotayushchem serdce. Klinicheskaya fiziologiya krovoobrashcheniya. 2005; 3: 18–23. (In Russ)]
Лицензия Creative Commons

Это произведение доступно по лицензии Creative Commons «Attribution-NonCommercial-ShareAlike» («Атрибуция — Некоммерческое использование — На тех же условиях») 4.0 Всемирная.