Temporary neurologic deficits in patients undergoing cardiac surgery with thoracic epidural supplementation

Abstract

s a e c w a t d d C s ENERAL ANESTHESIA (GA) remains the most common and preferred method of anesthesia for patients unergoing cardiac surgery. However, hemodynamic responses to racheal intubation, suction of the endotracheal tube, and extuation may lead to myocardial ischemia and increase the risk of yocardial infarction in patients with coronary artery disase.1,2 Thoracic epidural anesthesia (TEA) may also be used as n adjunct to GA or as the sole anesthetic during coronary rtery bypass graft surgery.3 Thus, detrimental hemodynamic hanges that may occur during GA alone may be avoided by sing TEA.4 Supplementation of GA with TEA may also proide improved conditions for coronary artery bypass surgery by ilating the coronary arteries and the internal mammary arteres.3 Additional potential advantages of TEA include enhanced nalgesia, improved pulmonary function, facilitation of extuation, and decreased cardiac arrhythmias during the intraoprative and immediate postoperative period. The potential disadvantages of using TEA include risk of ematoma formation, neurologic injury, and infection. The fear f epidural hematoma and neurologic injury weighs heavily on he minds of clinicians when epidural anesthesia is used, alhough epidural hematoma during cardiac surgery has not (yet) een reported. However, it is unlikely that clinicians will idely adopt the use of TEA in patients undergoing cardiac