• J. Cardiothorac. Vasc. Anesth. · Dec 2013

    High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated with Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients.

    • Michael Stenger, Anja Fabrin, Henrik Schmidt, Jacob Greisen, Poul Erik Mortensen, and Carl-Johan Jakobsen.
    • Department of Cardiothoracic & Vascular Surgery, Odense University Hospital, Denmark.
    • J. Cardiothorac. Vasc. Anesth.. 2013 Dec 1;27(6):1301-9.

    ObjectiveThe purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome.DesignRetrospective cohort study of prospectively registered data using population-based healthcare databases.ParticipantsOne thousand seven hundred thirteen consecutive patients scheduled for elective coronary artery bypass grafting, aortic valve replacement, mitral valve surgery, and combinations eligible for supplementation with epidural analgesia. One thousand sixteen patients were matched and analyzed.SettingUniversity hospital, single center.InterventionTo minimize bias and confounding, epidural patients were matched using EuroSCORE criteria to nonepidural in a 1:1 ratio requiring exact match on sex, age, patient factors, cardiac factors, and procedure type together with normal/moderate/poor left ventricular function, insulin-dependent diabetes, and on-pump/off-pump surgery. All together, 1,016 patients (508 each group) were identified with matching criteria.Measurements And Main ResultsOutcome parameters were 30-day and 6-month mortality, postoperative dialysis, stroke, and myocardial infarction. Univariate analysis showed that epidural analgesia was associated with lower 6-month mortality (p = 0.021), lower frequency of postoperative dialysis (p = 0.029), and lower frequency of myocardial infarction (p = 0.049). No difference was seen in stroke (p = 0.341). However, adjusted odds ratio of selected perioperative variables showed that HTEA only had a positive impact on the frequency of postoperative dialysis (0.22 [0.06-0.74]).ConclusionThis large, uniquely matched single-center cohort was generated, and, subject to the listed limitations the authors concluded that supplemental HTEA to general anesthesia had a better outcome in low-risk cardiac surgery patients, with a significantly lower 6-month mortality rate compared with the control group. However, regression analysis revealed that HTEA only had an independently positive effect on the frequency of postoperative dialysis.Copyright © 2013 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…