Epidural Analgesia Improves Outcome in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Bignami, Elena; Landoni, Giovanni; Biondi‐Zoccai, Giuseppe; Boroli, Filippo; Messina, M.; Dedola, E.; Nobile, Leda; Buratti, Luca; Sheiban, Imad; Zangrillo, Alberto

doi:10.1053/j.jvca.2009.09.015

Cited by 89 publications

(60 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Uncertainty remains in part because previous studies did not differentiate between neuraxial anesthesia alone vs the combination of neuraxial and general anesthesia. 5,[8][9][10] Contrary to other research findings, a post hoc analysis of patients at high risk for cardiovascular complications in the POISE trial showed that patients who received neuraxial blockade were actually at greater risk for cardiovascular complications. 10 We therefore conducted a large population-based study to explore this Ontario who are 65 yr of age or older.…”

contrasting

confidence: 68%

“…Their findings showed that the use of thoracic epidural anesthesia resulted in a lower risk of acute kidney injury and a composite outcome of myocardial infarction and mortality. 9 Another meta-analysis of almost 10,000 patients across 141 trials showed a non-significant reduction in both stroke and myocardial infarction with neuraxial anesthesia (used in combination with general anesthesia or alone) compared with general anesthesia alone. 5 Finally, a large post hoc analysis of patients at high risk for cardiovascular complications in the POISE trial found that patients who received neuraxial blockade (whether used alone or in combination) compared with general anesthesia alone were actually at greater risk for cardiovascular complications.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Nash

Mustafa

McArthur

et al. 2015

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose To determine whether combining spinal or epidural anesthesia with general anesthesia (combined anesthesia) reduces major medical complications of elective surgery compared with general anesthesia alone. Methods We conducted a propensity-matched population-based historical cohort study using large healthcare databases from Ontario, Canada. We identified patients undergoing 21 different elective procedures that were amenable to either combined anesthesia or general anesthesia alone in 108 hospitals from 2004 to 2011. We assessed the following four outcomes together as a composite and individually in the 30 days following surgery: acute kidney injury, stroke, myocardial infarction, and all-cause mortality. Results Prior to matching, we identified 21,701 patients receiving general anesthesia and 8,042 patients receiving combined anesthesia. After matching, our cohort included Author contributions Danielle M. Nash, Reem A. Mustafa, Sumit Sharan, and Amit X. Garg helped design the study. Duminda N. Wijeysundera contributed to the study design by suggesting operations to focus on and administrative codes/variables to use for the study. J. Michael Paterson contributed to the study design by suggesting administrative codes to use for anesthesia type. Christopher Vinden contributed to the study design by suggesting administrative codes to use to identify epidural insertions. Ron Wald contributed to the study design by providing clinical expertise regarding acute kidney injury. Blayne Welk contributed to the study design by suggesting the additional outcome of length of stay. P.J. Devereaux contributed to the study design by adding clinical expertise regarding cardiovascular events. Reem A. Mustafa developed the preliminary protocol, and Danielle M. Nash completed the study protocol. Danielle M. Nash, Reem A. Mustafa, Eric McArthur, Duminda N. Wijeysundera, J. Michael Paterson, Christopher Vinden, Ron Wald, Blayne Welk, P.J. Devereaux, and Amit X. Garg contributed to the interpretation of results. Daniel I. Sessler contributed to the interpretation of results particularly regarding discussion about intraoperative vs postoperative anesthesia use. Michael Walsh contributed to the interpretation of results particularly regarding the limitations of the study. Sumit Sharan contributed to the interpretation of the results through a dialogue regarding standard practice for epidural catheter insertions. Danielle M. Nash initiated and finalized the manuscript. 123Can J Anesth/J Can Anesth (2015) 62:356-368 DOI 10.1007 12,379 patients. Twenty-eight baseline characteristics were well-matched between the combined (n = 4,773) and general anesthesia groups (n = 7,606 Conclusion L'ajout de la rachianesthésie ou de l'anesthésie péridurale à l'anesthésie générale n'a pas été associé à une diminution du risque de complications médicales majeures pour 21 procédures chirurgicales électives différentes par rapport à l'anesthésie générale administrée seule.Neuraxial anesthesia (epidural and spinal anesthesia) is widely used f...

show abstract

contrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Nash

Mustafa

McArthur

et al. 2015

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…281 In those in whom emergency CABG for failed PCI is performed, morbidity and mortality rates are increased compared with those undergoing elective CABG, [287][288][289] resulting at least in part from the advanced age of many patients now referred for PCI, some of whom have multiple comorbid conditions and complex coronary anatomy. Several variables have been shown to be associated with increased perioperative morbidity and mortality rates, including 1) depressed LV systolic function, 290 2) recent ACS, 290,291 3) multivessel CAD and complex lesion morphology, 291,292 4) cardiogenic shock, 281 5) advanced patient age, 293 6) absence of angiographic collaterals, 293 7) previous PCI, 294 and 8) a prolonged time delay in transfer to the operating room. 293 In patients undergoing emergency CABG for failed PCI, an off-pump procedure may be associated with a reduced incidence of renal failure, need for intra-aortic balloon use, and reoperation for bleeding.…”

Section: Emergencymentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

View full text Add to dashboard Cite

“…This finding is further reinforced by a meta-analysis, which found that EDA, in addition to general anesthesia, reduced the incidence of perioperative acute renal failure in cardiac surgery [77]. Lidocaine may provide protection against IR injury by preventing miRNA dysregulation.…”

Section: Regional Anesthesiamentioning

confidence: 98%

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

et al. 2017

View full text Add to dashboard Cite

Background: Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence. Summary: The effects of anesthetic drugs on renal failure are particularly important in the context of kidney transplantation, since the conditions of preservation following removal profoundly influence the recovery of organ function. Currently, preservation procedures are typically based on the usage of a cold-storage solution. Some anesthetic drugs induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. A more thorough understanding of anesthetic effects on renal function can present a novel approach for developing organ-protective strategies. The aim of this review is to discuss the effects of different anesthetic drugs on renal function, with particular focus on IR injury. Many studies have demonstrated the organ-protective effects of some anesthetic drugs, specifically propofol, which indicate the potential of some anesthetics to introduce novel organ protective targets. This is not surprising, since lipid emulsions are major components of propofol, which accumulating data show provide organ protective effects against IR injury. Key Messages: Thorough understanding of the interaction between anesthetic drugs and renal function remains fundamental to the delivery of safe perioperative care and to optimizing outcomes after renal surgeries, particularly transplant procedures. Anesthetics can be repurposed for organ protection with more information about their effects, especially during transplant procedures. Here, we review the effects of different anesthetic drugs – specifically those that contain lipids in their structure, with special reference to IR injury.

show abstract

Epidural Analgesia Improves Outcome in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Cited by 89 publications

References 62 publications

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

Contact Info

Product

Resources

About