[Postoperative management following open heart surgery by thoracic epidural anesthesia]

The significance of thoracic epidural anesthesia as a postoperative analgesic-sedative was evaluated. Ninety-seven open heart surgery patients with average age of 64 years, were classified into: Non-Epidural (N) group, Epidural with butorphanol (B) group and Epidural with morphine (M) group, in each of which the pulmonary, circulatory and sedative states were studied. Anesthesia was induced with low-dose fentanyl and isoflurane-nitrous oxide-oxygen, and epidural catheter was inserted through Th 7-10 on the day before the operation for Epidural groups. Butorphanol 0.5-1.0 mg was administrated in B group, and morphine 2-5 mg in M group. The Epidural groups required only small amount of fentanyl, 5 micrograms.kg-1, were extubated earlier compared to N group, and showed higher postoperative cardiac index. As for the respiratory state, although PaCO2 was slightly higher in the Epidural group, there was no difference in oxygenation. The incidence of administration of postoperative analgesic-sedative was extremely low in the Epidural especially in M group. As long as the indication is appropriately selected, the epidural anesthesia will not have negative effect on the postoperative pulmonary and circulatory state, allows for an earlier extubation and has excellent sedative effect. It is an effective method for patient management following open heart surgery.