Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.09.015
Brazilian Journal of Anesthesiology
Review Article

Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?

Existe algum benefício em associar a anestesia neuroaxial à anestesia geral para revascularização miocárdica?

Fabiano Timbó Barbosa; Célio Fernando de Sousa Rodrigues; Aldemar Araújo Castro; Rafael Martins da Cunha; Tatiana Roa Bezerra Wanderley Barbosa

http://dx.doi.org/10.1016/j.bjane.2013.09.015 Braz J Anesthesiol, vol.66, n3, p.304-309, 2016
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Abstract

ABSTRACT BACKGROUND AND OBJECTIVES: The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE: To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT: The search was performed in Pubmed (January 1966 to December 2012), Embase (1974 to December 2012), The Cochrane Library (volume 10, 2012) and Lilacs (1982 to December 2012) databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. CONCLUSIONS: The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.

Keywords

General anesthesia, Subarachnoid anesthesia, Thoracic epidural anesthesia, Systematic review, Mortality, Evidence

Resumo

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso da anestesia neuroaxial em cirurgia cardíaca é recente, porém os efeitos hemodinâmicos dos anestésicos locais e a anticoagulação podem trazer riscos aos pacientes. OBJETIVO: Revisar os benefícios da anestesia neuroaxial em cirurgia cardíaca para revascularização miocárdica por meio de uma revisão sistemática de revisões sistemáticas. CONTEÚDO: Foi feita pesquisa nas bases de dados Pubmed (de janeiro de 1966 a dezembro de 2012), Embase (1974 a dezembro 2012), The Cochrane Library (volume 10, 2012) e Lilacs (1982 a dezembro de 2012) em busca de artigos de revisões sistemáticas. Foram analisadas as seguintes variáveis: mortalidade, infarto do miocárdio, acidente vascular cerebral, tempo de internação hospitalar, arritmias e hematoma peridural. CONCLUSÕES: O uso da anestesia neuroaxial para revascularização miocárdica permanece controverso. O maior benefício encontrado por meio desta revisão foi a possibilidade de redução das arritmias pós-operatórias, porém esse resultado foi contraditório entre as evidências identificadas. Os resultados das evidências encontradas referentes à mortalidade, ao infarto do miocárdio, ao acidente vascular cerebral e ao tempo de internação hospitalar não mostraram maior efetividade da anestesia neuroaxial.

Palavras-chave

Anestesia geral, Anestesia subaracnoidea, Anestesia epidural torácica, Revisão sistemática, Mortalidade, Evidências

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