Anesthesiology Resident, Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Anesthesiology. 2011 Feb;114(2):262-70. doi: 10.1097/ALN.0b013e318201d2de.
The addition of thoracic epidural anesthesia (TEA) to general anesthesia (GA) during cardiac surgery may have a beneficial effect on clinical outcomes. TEA in cardiac surgery, however, is controversial because the insertion of an epidural catheter in patients requiring full heparinization for cardiopulmonary bypass may lead to an epidural hematoma. The clinical effects of fast-track GA plus TEA were compared with those of with fast-track GA alone.
A randomized controlled trial was conducted in 654 elective cardiac surgical patients who were randomly assigned to combined GA and TEA versus GA alone. Follow-up was at 30 days and 1 yr after surgery. The primary endpoint was 30-day survival free from myocardial infarction, pulmonary complications, renal failure, and stroke.
Thirty-day survival free from myocardial infarction, pulmonary complications, renal failure, and stroke was 85.2% in the TEA group and 89.7% in the GA group (P = 0.23). At 1 yr follow-up, survival free from myocardial infarction, pulmonary complications, renal failure, and stroke was 84.6% in the TEA group and 87.2% in the GA group (P = 0.42). Postoperative pain scores were low in both groups.
This study was unable to demonstrate a clinically relevant benefit of TEA on the frequency of major complications after elective cardiac surgery, compared with fast-track cardiac anesthesia without epidural anesthesia. Given the potentially devastating complications of an epidural hematoma after insertion of an epidural catheter, it is questionable whether this procedure should be applied routinely in cardiac surgical patients who require full heparinization.
心脏手术中全身麻醉（GA）联合胸段硬膜外麻醉（TEA）可能对临床结果有有益影响。然而，心脏手术中 TEA 存在争议，因为在需要体外循环全身肝素化的患者中插入硬膜外导管可能导致硬膜外血肿。本研究比较了快速 GA 加 TEA 与单纯快速 GA 的临床效果。
在 654 例择期心脏手术患者中进行了一项随机对照试验，这些患者被随机分为联合 GA 和 TEA 组与单纯 GA 组。术后 30 天和 1 年进行随访。主要终点是 30 天无心肌梗死、肺部并发症、肾衰竭和中风的生存率。
TEA 组 30 天无心肌梗死、肺部并发症、肾衰竭和中风的生存率为 85.2%，GA 组为 89.7%（P = 0.23）。在 1 年随访时，TEA 组无心肌梗死、肺部并发症、肾衰竭和中风的生存率为 84.6%，GA 组为 87.2%（P = 0.42）。两组术后疼痛评分均较低。
与无硬膜外麻醉的快速心脏麻醉相比，本研究未能证明 TEA 在择期心脏手术后主要并发症的频率上具有临床相关益处。鉴于硬膜外导管插入后硬膜外血肿的潜在破坏性并发症，对于需要全身肝素化的心脏手术患者，是否应常规应用该程序存在疑问。
