Comparison of Three Different Epidural Solutions in Cardiac Surgery for Stress Protection
Bibliographic record
Abstract
Background: Different solutions are possible for thoracic epidural analgesia in cardiac surgery. So far, local anesthetics alone or in combination with either clonidine or opioids have been used. Aims: To determine the stress protection provided by different epidural solutions throughout cardiac surgery. Study Design: A randomized, prospective, double blind study in patients undergoing off-pump coronary artery bypass grafting (OPCAB), randomized in three different groups. Thoracic epidural analgesia was installed more than 1 h before application of heparin at levels of T2 to T4; analgesia was provided by 8 ml of bupivacaine 0.25% 15 min prior to surgery and extubation, and 10 ml/h during and up to 72 h after surgery using one of the following regimens: bupivacaine 0.125% solely, bupivacaine 0.125% with fentanyl 3 μg/mL or bupivacaine 0.125% with clonidine 0.6 μg/mL. Patients were blockrandomized for one of the three treatments. Cortisol and glucose values were determined before surgery, at extubation and 1h and 3h after surgery. Pain scores were assessed up to 48 h after surgery. Hemodynamic stability was also recorded in form of heart rate, systolic and diastolic blood pressure. Multi-comparison ANOVA and Chi-square test were used to compare the data, presented as mean (SD) or median (25 th and 75 th percentile), P < 0.05. Study Setting: A cardiac surgery unit at a tertiary university hospital. Participants: Forty-two patients undergoing OPCAB were enrolled. Main Results: All patient data as well hemodynamic stability were not different between the three groups. All patients were successfully extubated in theatre immediately after surgery. Pain control was good and not significantly different between the groups. Mean glucose concentrations ± SD before surgery and (significantly higher) 3h after surgery were 5.4 ± 1.0 mmol l -1 and 8.4 ± 1.6 mmol l -1 for bupivacaine alone, 5.2 ± 0.5 mmol l -1 and 8.5 ± 2.2 mmol l -1 for bupivacaine plus fentanyl and 5.5 ± 1.6 mmol l -1 and 9.5 ± 2.1mmol l -1 for bupivacaine and clonidine, respectively. The mean cortisol values ± SD in the pre-operative period and 3h after surgery were 413 ± 162 nmol l -1 and 562 ± 173 nmol l -1 for bupivacaine alone, 393 ± 107 nmol l -1 and 581 ± 265 nmol l -1 for bupivacaine and fentanyl and 409 ± 159 nmol l -1 and 570 ± 160 nmol l -1 for bupivacaine and clonidine, respectively. There were no significant differences between the groups. Conclusions: We conclude that short-term stress protection with TEA is equally effective with solely bupivacaine, bupivacaine with fentanyl or clonidine.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".