Temporary neurologic deficits in patients undergoing cardiac surgery with thoracic epidural supplementation

Chakravarthy, Murali; Shivananda, Nadiminti; Krishnamoorthy, Jayaprakash; Thimmannagowda, Patil; Jawali, Vivek; Royse, Colin; Minzter, Beth H.

doi:10.1053/j.jvca.2004.05.012

Cited by 12 publications

(6 citation statements)

References 52 publications

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“…This perceived increased risk cannot be quantified, but the incidence of epidural hematoma after catheter insertion without heparinization is approximately 1 in 10,000. [ 28 ] Such a risk must be balanced by important clinical advantages if the technique is to be justified. In OPCAB surgery, the need for heparinization is reduced to half the dose as that used for CCABG, making the use of epidural anesthesia a more attractive approach.…”

Section: Discussionmentioning

confidence: 99%

Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

et al. 2015

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Objective:Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha(TNF ά), interleukin-6 and leucocyte count.Design:A prospective randomised non blind study.Setting:A clinical study in a multi specialty hospital.Participants:Eighty six patients.Material and Methods/intervention:The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin: – 6, TNF ά, cortisol, Troponin – I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis.Primary Outcomes:Postoperative complications, total intensive care unit stay and hospital stay.Secondary Outcome:Stress response.Result:Study group showed decreased Interlukin – 6 at day 2, TNF ά at day 2 and 5, troponin I at day 5, and decreased total hospital stay (p < 0.05).Conclusion:Thoracic epidural anesthesia decreases stress and inflammatory response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.

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Section: Discussionmentioning

confidence: 99%

Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

et al. 2015

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“…One of the mechanistic predispositions is a heightened sympathetic tone and vagal rebound [23]. High regional anaesthesia of the first five thoracic segments resulting in blocks in cardiac afferent and efferent fibres and lower catecholamine release has been demonstrated in CABG patients [19,20,24,25]. A consistent effect of thoracic epidural anaesthesia on the cardiovascular system is vasodilatation [14].…”

Section: Discussionmentioning

confidence: 99%

Superior haemodynamic stability during off-pump coronary surgery with thoracic epidural anaesthesia: results from a prospective randomized controlled trial

Rajakaruna

Rogers

Pike

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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“…This perceived increased risk cannot be quantified, but the incidence of epidural hematoma after catheter insertion without heparinization is approximately 1 in 10,000. 21 Such a risk must be balanced by important clinical advantages if the technique is to be justified. In OPCAB surgery, the need for heparinization is reduced to half the dose as that used for conventional CABG, making the use of epidural anesthesia a more attractive approach.…”

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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Temporary neurologic deficits in patients undergoing cardiac surgery with thoracic epidural supplementation

Cited by 12 publications

References 52 publications

Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

Superior haemodynamic stability during off-pump coronary surgery with thoracic epidural anaesthesia: results from a prospective randomized controlled trial

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

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