Thoracal epidural anaesthesia in cardiac surgery

Experimental animal data demonstrate that cardiac sympathetic blockade has a beneficial effect on blood flow redistribution after myocardial infarction and functional recovery following myocardial ischemia. The artificial sympathectomy of the cardiac nerves can be performed by TEA (thoracic epidural anesthesia) without jeopardizing systemic hemodynamics. Further investigations will have to compare anaesthetic techniques with and without TEA on myocardial stunning in order to validate these experimental observations for clinical anaesthesia. The clinical data regarding TEA in cardiac surgery imply potential benefit for the perioperative management. Both, the perioperative sympathetic blockade of the cardiac nerves and an effective postoperative analgesia seem to be the key to suppression of the perioperative hormonal stress response and thereby to a favorable impact on cardiac morbidity in this patient group. High TEA is necessary in order to block the cardiac nerves. For this purpose TEA must include at least the levels Th1-Th5. If the cardiac nerves are not or only partially blocked, a sympathetic reflex activation of the cardiac nerves may occur with a subsequent detrimental impact on cardiac morbidity due to coronary vasoconstriction. TEA facilitates early extubation and thereby earlier transfer from the ICU with the potential of cost savings.