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Epidural anesthesia in cardiac surgery: is there an increased risk?
1Department of Cardiothoracic Anesthesia, Copenhagen Heart Center, Hellerup, Denmark.
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.
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