Practice in anestHesia: intratHecal MorPHine for off PuMP coronary artery byPass graft

Abstract

Pump.
Address for correspondence :
Dr. Bishwas Pradhan
Institute of Medicine, TU Teaching Hospital, Maharajgunj, Kathmandu, Nepal
Email: biswaspradhan@yahoo.com
Received Date : 12th Aug, 2005
Accepted Date : 18th May, 2006
CaSE rEPort J Nep Med assoc 2006; 45: 316-322
Off pump coronary artery bypass grafting is gaining popularity because of its beneficial effects like
reduced inflammatory response, early extubation, reduced hospital & ICU stay, less homologous
blood transfusion & reduced cost. Here we report a case of left anterior descending artery blockade
who had undergone off pump coronary artery bypass grafting. In this case we used intrathecal
morphine with heavy bupivcaine to provide intraoperative as well as post operative analgesia.
Though intrathecal morphine has been used as analgesia in cardiac surgeries, the use of intrathecal
morphine with bupivacaine is less reported. It not only provides intense analgesia which helps for
early extubation & hemodynamic stability but also provides calm & quiet surgical field with slow
beating heart & aids in critical time of vessel anastomosis. We have also discussed the other aspects
of anesthetic management with little elaboration in surgical aspect as well.

Key Words: Bupivacaine, Intrathecal, Morphine, Off Pump.