[Efficacy of epidural analgesia in minimally invasive direct coronary artery bypass surgery].

Minimally invasive direct coronary artery bypass surgery (MIDCAB), coronary bypass grafting with small thoracotomy using no cardiopulmonary bypass (CPB), became popular recently. To attenuate perioperative stress-response, we used epidural analgesia (EPI) with general anesthesia for MIDCAB operation. In this study, we compared retrospectively 11 cases of MIDCAB managed with EPI [ED (+)], and 14 cases of MIDCAB anesthetized without using EPI [ED (-)], concerning extubation time, ICU stay, hospital stay and perioperative complications. The mean time from cessation of general anesthesia to extubation was significantly shorter in ED (+) patients (0.5 hours) when compared to ED (-) patients (18.2 hours). Mean periods of ICU stay and hospital stay were, also, shorter in ED (+) patients (2.1 days, 30.5 days, respectively) when compared to ED (-) (4.3 days, 45.1 days, respectively) patients. We experienced ventricular tachycardia in three patients of ED (-). No major complication occurred in ED (+) patients. These results suggest that EPI shortened extubation time, ICU and hospital stay for MIDCAB patients.

Ketamine suppresses the production and release of endothelin 1 from cultured bovine endothelial cells.

UNLABELLED: Endothelins play important roles in the regulation of vascular tone. We examined the effect of ketamine on the secretion of endothelin 1 (ET-1) and its precursor, "big" ET-1, from bovine carotid artery endothelial cells (BCAECs). After confluent BCAEC cultures were incubated for 24 h with various concentrations of ketamine, the antigen levels for both ET-1 and big ET-1 in the culture medium were determined by using sandwich enzyme-linked immunosorbent assays. The precursor protein ET-1 (preproET-1) mRNA levels were assessed by using Northern blotting. On incubation in fresh medium, the BCAECs time-dependently produced and secreted ET-1 into the culture medium. The exposure of BCAECs to ketamine dose-dependently decreased the secretion of ET-1 and big ET-1 in both the serum-free and serum-containing conditions. Approximately 40% inhibition was attained by treatment with 100 microM ketamine for 24 h. The mRNA encoding preproET-1 was expressed much more slowly and to a lesser extent in the presence of ketamine. These results suggest that ketamine suppresses the production and release of big ET-1 and, therefore, the level of mature ET-1 in vascular endothelial cells. IMPLICATIONS: Endothelins are important in the regulation of vascular tone. The effect of anesthetics on the production of endothelins is unknown. We examined the effect of an anesthetic agent, ketamine, on the production and secretion of endothelin 1 from cultured vascular endothelial cells and found that ketamine suppressed them.

[Epidural anesthesia reduces mortality rate in the patients after emergency abdominal surgery].

Stress response and increased sympathetic stimulation constrict gastrointestinal blood vessels. In patients after abdominal surgery, anastomotic leakage and bacterial translocation may occur as a result of gastrointestinal hypoperfusion. These patients are at risk for severe SIRS and MOF, especially after emergency surgery. Epidural anesthesia decreases sympathetic stimulation and accordingly increases gastrointestinal blood flow. The purpose of this study was to test the hypothesis that epidural anesthesia has a beneficial effect on patients after emergency abdominal surgery. Seventy-seven patients older than 50 years of age having undergone emergency abdominal surgery were studied. Thirty-nine patients received general anesthesia alone (GA) and 38 patients received epidural anesthesia (EA). The data on APACHE II score, fluid intake and output management, mortality rate, and others of the subjects were collected from patient charts. The mortality rate 3 months after surgery in group GA (35.9%) was significantly higher than that in group EA (5.3%) (P < 0.01). There was no difference in APACHE II score and age. Fluid intake was significantly larger in group EA. To reduce mortality rate, epidural anesthesia and volume expansion are recommended for patients after emergency abdominal surgery.