• Masatoshi Nishi, Ai Usukaura, Yoko Kidani, Tsunehisa Tsubokawa, and Ken Yamamoto.
• Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. makun0119jp@ybb.ne.jp <makun0119jp@ybb.ne.jp>
• J. Cardiothorac. Vasc. Anesth. 2006 Oct 1;20(5):656-8.

ObjectiveThe purpose of this study was to compare the safety and success rates associated with the placement of a high thoracic epidural catheter in the sitting vs. the lateral decubitus position.DesignProspective randomized study.SettingUniversity hospital.ParticipantsForty-one patients scheduled for off-pump coronary artery bypass graft surgery (OPCAB) by means of high thoracic epidural anesthesia at Th 1/2.InterventionsThe epidural catheter was placed into the patients in the sitting or lateral decubitus position. The success rates, the time for catheter insertion, the incidence of adverse events, and the accuracy of the catheterization in both groups were compared.Measurements And Main ResultsThe success rates in both groups were comparable, whereas 20% of patients showed a vagal reflex during epidural catheterization in the sitting group (p < 0.05). The insertion time in the sitting group was significantly shorter than in the lateral decubitus group (p < 0.05). Accuracy at the first attempt to the Th1/2 epidural space was 93% in the sitting group and 73% in the lateral decubitus group, but there was no statistically significant difference (p = 0.186).ConclusionsIt is recommended to use the lateral decubitus position for high thoracic epidural catheterization in patients scheduled for OPCAB to avoid vagal reflexes.

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