Combined general and thoracic epidural anaesthesia: When is it indicated?

Abstract

Abstract There has been a large volume of recent literature which supports the use of combined general/thoracic epidural anaesthesia and postoperative epidural analgesia in high risk patients. Much of this literature has focused on patients undergoing surgery to treat cancer, patients undergoing vascular surgery, and patients at high risk for cardiovascular disease. In these groups of patients, combined thoracic epidural and general anaesthesia, with continuation of epidural analgesia into the postoperative period, has been shown to have certain advantages over general endotracheal anaesthesia followed by postoperative intravenous opioid analgesia. However, how the anaesthetic is conducted may be more important than merely placing an epidural catheter prior to induction of general anaesthesia. In this review, the authors will examine the physiological and clinical data underlying the advantages of combined thoracic epidural/general anaesthesia, examine how the conduct of the anaesthetic may be an important influence on clinical outcome, and discuss the indications for this technique of anaesthesia and postoperative analgesia.