Double-Blind Comparison of Combined General-Spinal Anesthesia to General Anesthesia for Coronary Artery Surgery
Condition: Coronary Artery Disease; Coronary Artery Bypass Surgery
MeSH terms: Coronary Artery Disease
Study type: Interventional
Phase: Phase 3

Summary: 
      Use of neuraxial agents in anesthesia for cardiac surgery is expanding. We have used combined
      general-spinal anesthesia for cardiac surgery for 12 years. We hypothesized that compared to
      general anesthesia, the combined techniques would provide comparable intraoperative
      hemodynamics and improved postoperative analgesia. This study subjected these techniques to a
      double-blind randomized trial.
    

Detailed description: 
      Use of neuraxial agents in anesthesia for cardiac surgery is expanding. We have used combined
      general-spinal anesthesia for cardiac surgery for 12 years. We performed a trial in order to
      determine if our clinical impressions of the techniques would be confirmed. We hypothesized
      that compared to general anesthesia, the combined techniques would provide comparable
      intraoperative hemodynamics and improved postoperative analgesia. This study subjected these
      techniques to a double-blind randomized trial.

      METHODS

      After IRB approval, 63 consenting patients undergoing non-emergent coronary artery bypass
      grafting (CABG) entered a randomized, double-blind trial. Patients received lorazepam 0.03
      mg/kg preoperatively, and midazolam 0.03 mg/kg during line insertion and induction. Spinal
      procedures, performed by an unblinded study anesthesiologist, preceded general anesthesia,
      which was induced with propofol and rocuronium, and maintained with isoflurane through CPB,
      and propofol thereafter. All caregivers were blinded to group assignment. Opioid and spinal
      management defined 3 groups:

      GA: Sufentanil IV: 3 μg/kg induction, 1 μg/kg x 2 prn; mock spinal SO: Sufentanil IV: 0.2
      μg/kg induction, 0.1 μg/kg x 2 prn; Spinal: sufentanil 50 μg, morphine 0.5 mg, hyperbaric SL:
      Sufentanil IV: 0.2 μg/kg induction, 0.1 μg/kg x 2 prn; Spinal: sufentanil 25 μg, morphine 0.5
      mg, bupivacaine 9.75 mg, hyperbaric

      When patients were stable in ICU, propofol was stopped and an extubation protocol begun.
      Patients received scheduled NSAID and prn opioid, IV or PO. The chi-square test and ANOVA
      using the Scheffe method for multiple comparisons were applied appropriately.

      The primary end points of the study were analgesic requirements, visual analogue pain scores,
      and duration of endotracheal intubation in the intensive care unit. Secondary endpoints were
      intraoperative hemodynamic variables, blood catecholamine and lactate levels, anesthetic
      supplementation, and vasoactive drug support.
    

Intervention name(s): spinal analgesia and anesthesia for coronary artery surgery
Intervention type(s): Procedure
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double
Primary purpose: Treatment
Keywords: coronary artery bypass surgery; anesthesia, general; anesthesia, spinal; heart-lung machine