High thoracic epidural anesthesia and coronary artery disease in surgical and non-surgical patients

Abstract

Epidural anesthesia does not decrease mortality or the incidence of myocardial infarction after coronary artery bypass grafting. It reduces the incidence of arrhythmias and respiratory complications and improves the quality of analgesia. High thoracic epidural anesthesia has been shown to be a safe and efficient technique for refractory angina that reduces the frequency of ischemic events and improves the clinical condition of patients.

Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery

“…241 The choice between general anaesthesia or neuraxial blockade will depend, therefore, on the particular pathophysiology of the heart condition and the goals sought. 242,243 When reaching T4, a reduction in cardiac sympathetic drive will appear, which will subsequently override beta blockade. However, beta receptors are still able to respond to catecholamines.…”

“…Nevertheless, high thoracic epidural should not be used in patients with PH, because blockade of the sympathetic cardiac nerves at T1 and T4 has a negative inotropic and chronotropic effect. 242,243,279,292,293 General anaesthesia is unavoidable in many surgical interventions. In these patients, it gives good haemodynamic and respiratory control.…”

Effects of the prolonged thoracic epidural analgesia on ventilation function and complication rate after the lung cancer surgery

“…General influence of the epidural analgesia. The epidural analgesia has been known since the beginning of the last century; therefore, its basic effects are considered to be clear (1,2). The influence on the cardiovascular system is complex and variable, depending on many factors such as the extent of sympathetic denervation, autonomous balance, circulating blood volume, pharmacological effect of the systematically absorbed anesthetic substance -opiate, adrenaline, or a drug for the local anesthesia.…”

“…Systematically absorbed local anesthetic decreases the bronchial activity too. TEA also decreases the perioperative stress and endocrine-metabolic reaction to the trauma caused by the surgery (1).…”