Clinical trial NCT04708080: Effects of Thoracic Epidural Analgesia in Geriatric Patients Undergoing Open Heart Surgery
Official title: Effect of Thoracic Epidural Analgesia on Short-term Outcome and Mortality in Geriatric Patients With Open Heart Surgery
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Epidural Analgesia
Mechanical Ventilation
Postoperative Complications
Analgesia
Keywords: thoracic epidural analgesia
Postoperative Complications
mortality
Mechanical Ventilation
open heart surgery
Lead sponsor: Karadeniz Technical University
Sponsor class: OTHER
First posted: 2021-01-13
Enrollment: 640
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: This study was planned as a retrospective (retrospective) study involving patients aged 65 and over who underwent elective open heart surgery between January 1, 2008 and December 31, 2019.

Brief summary: Elderly patients have a higher incidence of morbidity and mortality due to the interaction of various factors such as decreased physiological reserves, concomitant comorbidities, multiple drug use, cognitive dysfunction, and frailty. Surgical stress, pain and associated lung complications are common problems in open heart surgeries that can affect morbidity and mortality. With a good postoperative pain control and improved respiratory mechanics, complications that may develop in patients can be significantly prevented, and the hospital cost can be reduced and the workforce loss of patients can be reduced by reducing the length of hospital stay in the intensive care unit. Thoracic epidural analgesia (TEA) is an anesthetic analgesia method that has positive effects on many organ systems as well as providing good pain control and is frequently used in open heart surgery. The aim of this study is to investigate the effects of TEA on postoperative respiratory mechanics in geriatric patients, based on analgesia levels, extubation times, length of stay in intensive care, arterial blood gases, morbidity and mortality.

Detailed description: It has been shown that stress response suppression by providing good analgesia with local or systemic methods in the postoperative period reduces mortality and morbidity in many types of surgery. Especially the physiological changes that occur with aging, comorbid diseases and the drugs used in the treatment of these diseases, the type of surgery performed, the postoperative pain treatment and the anesthesia method chosen affect mortality and morbidity Thoracic epidural analgesia (TEA) has provided similar benefits in open heart surgery by suppressing stress response and increasing functional residual capacity with positive effects on the diaphragm, as well as providing good analgesia with thoracic sympathetic block.TEA has positive effects on postoperative pulmonary and circulatory system in selected eligible patients; It allows earlier extubation and provides excellent analgesia. It has been reported that TEA combined with general anesthesia in elective cardiac surgery offers a significant advantage compared to general anesthesia in terms of intensive care and hospital stay, improvement or morbidity. Studies have shown that TEA reduces surgical stress response, improves hemodynamic stability, and reduces the incidence of myocardial ischemia after coronary artery bypass surgery (CABG) as well as supraventricular arrhythmias in the postoperative period .

Based on these studies, the investigators determined the effects of TEA combined with general anesthesia on postoperative respiratory mechanics, analgesia levels, extubation times, length of stay in intensive care, arterial blood gases, effects on organ functions, morbidity and mortality in geriatric patients with open heart surgery in our hospital. the investigators aimed to contribute to the literature by reviewing it retrospectively.

Eligibility criteria: Inclusion Criteria:

* Elective patients undergoing open heart surgery

Exclusion Criteria:

* Emergency operations
* Patients whose data cannot be reached
* Patients younger than 65
* Patients whose records could not be accessed and who were excluded from the study group procedure in which they were included for any reason will not be included in the study.

Primary outcomes:
measure: the effect of thoracic epidural analgesia
timeFrame: up to 4 weeks
measure: the effect of thoracic epidural analgesia
timeFrame: postoperative period 3 day
measure: the effect of thoracic epidural analgesia
timeFrame: 1 day
measure: the effect of thoracic epidural analgesia
timeFrame: 1 month
measure: the effect of thoracic epidural analgesia
timeFrame: up to 4 weeks
measure: the effect of thoracic epidural analgesia
timeFrame: 1 year
Secondary outcomes:
Other outcomes:
Locations:
city: Trabzon
country: Turkey
facility: Karadeniz Technical University
Study officials:
References: