R Sanchez1, E Nygård. 1. Department of Cardiothoracic Anesthesia, Copenhagen Heart Center, Hellerup, Denmark.
Abstract
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.
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.