Epidural anesthesia in cardiac surgery: Is there an increased risk?

Objective: To assess the risk of hemorrhagic complications associated with epidural anesthesia in patients undergoing coronary artery bypass grafting. Design: A prospective study. Setting: A cardiac surgical center associated with a university. Participants: Five hundred fifty-eight consecutive patients scheduled for coronary artery bypass surgery. Interventions: A Tuohy 18G epidural catheter was inserted the day before surgery in all patients. Measurements and Main Results: Preoperative coagulation tests, such as platelet count and prothrombin time, were performed. No patient was on oral anticoagulation therapy or had coagulation disorders. Four hundred three (72%) patients were on antiplatelet therapy, which was terminated at least 1 week before surgery. The epidural catheter was left in situ for up to 5 days. All patients were observed daily for signs of spinal cord compromise, such as radicular back pain or progressive sensory or motor deficits. There were no documented spinal hematomas. Conclusion: By following certain guidelines, the risk for the development of epidural hematoma is not increased in patients undergoing epidural anesthesia during cardiac surgery. Copyright (C) 1998 by W.B. Saunders Company.