Thoracic epidural analgesia in coronary artery bypass graft surgery:: Seven years' experience

Objective: To evaluate the risk of neurologic complications caused by an epidural hematoma in a series of patients who had coronary artery bypass graft surgery with cardiopulmonary bypass under combined general and thoracic epidural anesthesia (TEA). Design: Prospective observational study. Setting: General hospital associated with a university. Participants: Seven hundred fourteen patients who had coronary artery bypass grafting surgery over a 7-year period. Interventions: An epidural catheter was inserted at T-1-T-3 as soon as the patient was in the operating room and local anesthetic was administered as a bolus and then as a continuous infusion throughout the operation and postoperatively. A set of safety guidelines was routinely followed. A protocol for postoperative neurologic evaluation was used to rule out any signs of spinal compression. Measurements and Main Results: Preoperatively, a battery of coagulation tests was systematically performed including APTT, platelet count, and prothrombin time. Antiplatelet drugs (aspirin) were stopped at least 7 days before surgery. No patient required parenteral opiates postoperatively. Seventy-five percent of the patients were extubated in the operating room. No clinical epidural hematomas were detected. Conclusion: In this study, some of the benefits previously reported during cardiac surgery under TEA, such as excellent analgesia and early extubation, were confirmed. In addition, the series adds further evidence that adherence to a set of standard safety measures, in this setting, averts the occurrence of symptomatic epidural hematomas. (C) 2003 Elsevier Inc. All rights reserved.