[Cardioprotection by thoracic epidural anesthesia? : meta-analysis]

Area of Science:

• Anesthesiology
• Cardiology
• Critical Care Medicine

Background:

• Thoracic epidural analgesia (EDA) is theorized to offer cardioprotective benefits during noncardiac surgery.
• Previous meta-analyses yielded conflicting results regarding EDA's impact on perioperative survival.
• This study aimed to clarify EDA's role in reducing cardiac morbidity and mortality.

Purpose of the Study:

• To evaluate the potential of thoracic epidural analgesia (EDA) to reduce perioperative cardiac morbidity and mortality.
• To analyze available randomized controlled trials (RCTs) on thoracic EDA in noncardiac surgery.
• To provide a quantitative systematic review of the current evidence.

Main Methods:

• Systematic literature search across major medical databases (Med-Line, Embase, etc.).
• Inclusion of RCTs published from 1980 to 2008 involving noncardiac surgery patients.
• Quantitative systematic review using a fixed-effects model with Review Manager 4.1.

Main Results:

• Nine studies comprising 2,768 patients were analyzed.
• Thoracic EDA did not significantly reduce perioperative mortality (Peto OR: 1.08, 95% CI 0.74-1.58).
• A trend towards lower perioperative myocardial infarction was observed but lacked statistical significance (Peto OR: 0.65, 95% CI 0.4-1.05).

Conclusions:

• Thoracic EDA did not demonstrate a significant positive effect on perioperative in-hospital mortality in noncardiac surgery.
• The capacity of thoracic EDA to decrease perioperative myocardial infarction rates remains uncertain.
• Further research may be needed to definitively establish the cardioprotective role of thoracic EDA.