A survey of spinal and epidural techniques in adult cardiac surgery

Goldstein, Sheldon; Dean, David; Kim, Se Jun; Cocozello, Kim; Grofsik, Julie; Silver, Paula T.; Cody, Ronald P.

doi:10.1053/jcan.2001.21937

Cited by 65 publications

(30 citation statements)

References 42 publications

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“…In this context, the addition of regional to general anesthesia, with its demonstrated benefits in adult and pediatric patients undergoing major surgery, is receiving increasing attention from anesthetists and cardiac surgeons. [2][3][4][5][6][7] Regional anesthesia may attenuate adverse physiologic stress responses associated with cardiothoracic surgery, including alterations in circulatory (tachycardia, hypertension, vasoconstriction), metabolic (increased catabolism and cortisol release), immunologic (impaired immune response), and hemostatic (platelet activation) systems. 8 -12 Two recent randomized, controlled trials 3,4 have investigated the potential benefits of thoracic epidural anesthesia in patients undergoing conventional CABG with cardiopulmonary bypass (CPB) and cardioplegic arrest.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Anesthesia Improves Early Outcomes in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

Caputo

Alwair²,

Rogers³

et al. 2011

Anesthesiology

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Background:The aim of this two-center, open, randomized, controlled trial was to evaluate the impact of thoracic epidural anesthesia on early clinical outcomes in patients undergoing off-pump coronary artery bypass surgery. Methods: Two hundred and twenty-six patients were randomized to either general anesthesia plus epidural (GAE) (n ϭ 109) or general anesthesia only (GA) (n ϭ 117). The primary outcome was length of postoperative hospital stay. Secondary outcomes were: arrhythmia, inotropic support, intubation time, perioperative myocardial infarction, neurologic events, intensive care stay, pain scores, and analgesia requirement. Results: Baseline characteristics were similar in the two groups. One patient died in the GAE group. Median postoperative stay was significantly reduced in the GAE, com-

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Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Anesthesia Improves Early Outcomes in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

Caputo

Alwair²,

Rogers³

et al. 2011

Anesthesiology

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“…Anzumerken ist jedoch, dass in einem Kollektiv koronarkranker Patienten aufgrund der Begleitmedikation bereits präoperativ von einer höheren Präva-lenz an Gerinnungsstörungen ausgegangen werden muss; insbesondere kann die Thrombozytenfunktion oftmals durch Acetylsalicylsäure oder Aggregationshemmer der neueren Generation beeinträchtigt sein. Trotz der bestehenden Gerinnungsproblematik wird die TEA in Kombination mit einer Allgemeinanästhesie v. a. in den USA, seltener auch in Europa, routinemäßig im Rahmen der koronaren Bypasschirurgie auch unter Einsatz der Herz-LungenMaschine durchgeführt [10]. Komplikationen wie epidurale Hämatome sind bei diesem Patientenkollektiv in der Literatur bisher nicht beschrieben.…”

Section: Methodikunclassified

“…Komplikationen wie epidurale Hämatome sind bei diesem Patientenkollektiv in der Literatur bisher nicht beschrieben. Auch eine bereits 1994 durchgeführte, weltweite Befragung an 71 herzchirurgischen Zentren, die TEA anwenden, ergab keinerlei neurologische Komplikationen in Zusammenhang mit der TEA [10]. Einen Schub erlangte die TEA im Rahmen der Koronarchirurgie, als mit der Einführung minimal-invasiver Techniken wie der Operation am schlagenden Herzen auf eine Vollheparinisierung verzichtet werden konnte; TEA und Allgemeinanästhesie sind in vielen Zentren bereits das Standardverfahren für Operationen am schlagenden Herzen [22].…”

Section: Methodikunclassified

Koronare Bypassoperation mit kompletter medianer Sternotomie am wachen Patienten in hoher thorakaler Periduralanästhesie

et al. 2002

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“…In den vergangenen Jahren wurde zunehmend über die positiven Effekte einer TEA in Kombination mit einer Allgemeinanäs-thesie berichtet ( [24,42,64]; . Tab.…”

Section: Thorakale Epiduralanästhesieunclassified

Koronare Bypasschirurgie am wachen Patienten

Byhahn

Meininger²,

Kessler³

2008

Anaesthesist

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Patients undergoing coronary artery bypass grafting increasingly show severe co-morbidities, which can negatively affect the outcome. Recent developments in cardiac surgery have therefore focused on minimizing the invasiveness of the procedure by revascularization on the beating heart without cardiopulmonary bypass, and by reducing surgical trauma using smaller surgical incisions. Progress in minimally invasive cardiac surgery has led to minimally invasive anesthesia, i.e. using high thoracic epidural anesthesia as the sole technique in the conscious patient (awake coronary artery bypass grafting, ACAB). Published data on ACAB procedures in smaller cohorts have demonstrated that the procedure is safe. Significant complications occurred in 7.1% of patients. A particular cause of concern during ACAB surgery is the development of spinal epidural hematoma the risk of which has been estimated to be as high as 1:1,000. A thorough risk-benefit analysis has therefore to be made. Currently, ACAB surgery remains limited to few specialized centers and highly selected patients.

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A survey of spinal and epidural techniques in adult cardiac surgery

Cited by 65 publications

References 42 publications

Thoracic Epidural Anesthesia Improves Early Outcomes in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

Thoracic Epidural Anesthesia Improves Early Outcomes in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

Koronare Bypassoperation mit kompletter medianer Sternotomie am wachen Patienten in hoher thorakaler Periduralanästhesie

Koronare Bypasschirurgie am wachen Patienten

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