High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated With Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients

Stenger, Michael R.; Fabrin, Anja; Schmidt, Henrik; Greisen, Jacob; Mortensen, Poul Erik; Jakobsen, Carl-Johan

doi:10.1053/j.jvca.2012.12.001

Cited by 18 publications

(20 citation statements)

References 31 publications

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“…Similarly, in the propensity score, matched analysis, patients who received EA had decreased rates of respiratory failure/pneumonia and death after a pancreatectomy. In addition, patients who received EA also had decreased rates of acute renal failure, an association that has also been reported with EA in other types of operations …”

Section: Discussionsupporting

confidence: 64%

“…In addition, patients who received EA also had decreased rates of acute renal failure, an association that has also been reported with EA in other types of operations. 4,18 In multivariate analyses, pancreatectomies performed at hospitals in the lowest volume quartile were associated with increased LOS, increased hospital charges and increased inpatient mortality. Previous studies have found an association between lower pancreatectomy volume hospitals and worse peri-operative outcomes, 19,20 and this study confirms this finding.…”

Section: Discussionmentioning

confidence: 99%

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Improved peri-operative outcomes with epidural analgesia in patients undergoing a pancreatectomy: a nationwide analysis

Sanford

Hawkins

Fields

2015

HPB

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Improved peri-operative outcomes with epidural analgesia in patients undergoing a pancreatectomy: a nationwide analysis

Sanford

Hawkins

Fields

2015

HPB

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“…One small RCT showed a significant decrease in the risk of AKI in patients undergoing CABG surgery who received a thoracic epidural (159). A larger cohort study examining the use of TEA in patients undergoing cardiac surgery found a decreased need for dialysis (160). The results of these studies must be balanced by the failure of a Cochrane Database Review to show a mortality reduction in patients undergoing cardiac surgery who received TEA (161) as well as the potential risk associated with the use of TEA in a patient who may require full heparinization.…”

Section: Prevention Of Aki Nonpharmacologic Strategiesmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

261

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…Stenger et al . [ 15 ] in his study of High thoracic epidural analgesia as an adjunct to general anesthesia was associated with better outcome in low-to-moderate risk cardiac surgery patients has shown that addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients enhance the fast-track and improvement in outcome. In our study fast tracking was better in Group L as compared with Group U in comparison to time to awakening and extubation and ICU stay.…”

Section: Discussionmentioning

confidence: 99%

Comparison of upper thoracic epidural analgesia versus low thoracic epidural analgesia in off-pump coronary artery bypass graft for perioperative pain management and fast tracking

et al. 2020

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Background: Upper thoracic epidural analgesia (TEA) is compared with lower thoracic epidural analgesia for the perioperative pain management and fast tracking in patients undergoing off pump coronary artery bypass grafting (OPCAB) surgery for the intraoperative hemodynamic, quality of analgesia, incentive spirometry, time to awakening & extubation and intensive care unit (ICU) duration. Materials and Methods: A prospective, randomized comparative clinical study was conducted with total of 60 patients randomized to either Group U: Upper TEA ( n = 30) or Group L: Lower TEA ( n = 30). Visual analog scale (VAS) was recorded in both the groups during rest and deep breathing at the various time intervals postextubation. Both the groups were also compared for intraoperative hemodynamics, incentive spirometry, time to awakening, and extubation and ICU duration. Statistical analysis was performed using the independent Student's t -test. A value of P < 0.05 was considered statistically significant. Results: Postextubation VAS score at rest and deep breathing at 0, 3, 6, 12, 24, 36, and 48 h were statistically significant in both groups ( P ≤ 0.05). Incentive spirometry, time to awakening and extubation and duration of ICU stay were also statistically significant ( P ≤ 0.05) between the groups. Conclusion: Lower thoracic epidural was better than upper thoracic epidural in perioperative pain management and fast tracking in OPCAB surgery.

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High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated With Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients

Cited by 18 publications

References 31 publications

Improved peri-operative outcomes with epidural analgesia in patients undergoing a pancreatectomy: a nationwide analysis

Improved peri-operative outcomes with epidural analgesia in patients undergoing a pancreatectomy: a nationwide analysis

AKI Associated with Cardiac Surgery

Comparison of upper thoracic epidural analgesia versus low thoracic epidural analgesia in off-pump coronary artery bypass graft for perioperative pain management and fast tracking

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