Original ArticlesThoracic epidural analgesia in coronary artery bypass graft surgery: Seven years' experience☆,☆☆
Section snippets
Methods
The authors studied the neurologic risk caused by epidural hematoma (EH) in coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) under TEA. The hospital ethics commission approved the investigation that involved strict parameters for inclusion. All patients gave verbal and written consent to their participation in the trial, after the risks involved in the anesthetic techniques used (both general and regional) had been clearly explained to them.
Between May 1995 and
Results
Between June 1995 and May 2002, 920 patients had CABG surgery in this hospital. The study group included 714 of these patients, but 41 were excluded because they preferred a conventional anesthetic technique. Other patients were excluded because they were emergencies (72) and 23 because of their abnormal coagulation findings. Insufficient time from the suspension of treatment with aspirin, clopidogrel, or NSAIDs ruled out 57 patients. A further 9 cases were excluded after failed epidural
Discussion
There are 2 aspects of the use of TEA in cardiac surgery that still need to be studied: (1) whether it really provides any benefit, and (2) whether the risk of EH is higher than in other surgical fields. Study of these 2 aspects can, and probably should, be done separately because they need different designs and sample sizes. Although this study had no control group and was basically designed to study neurologic risk, other variables were included: the authors observed excellent postoperative
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Address reprint requests to Miguel Cantó Pastor, Servicio de Anestesiología. Hospital General de Alicante, C/ Pintor Baeza s/n, Alicante 03010, Spain. E-mail: [email protected]
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