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Anesth Analg 2006;102:45-64
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000183650.16038.f6

CARDIOVASCULAR ANESTHESIA

Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery

Mark A. Chaney, MD

Department of Anesthesia and Critical Care, University of Chicago, Illinois

Address correspondence and reprint requests to Mark A. Chaney, MD, Department of Anesthesia and Critical Care, University of Chicago, 5841 South Maryland Ave., MC-4028, Chicago, IL 60637. Address e-mail to mchaney{at}dacc.uchicago.edu.

Adequate postoperative analgesia prevents unnecessary patient discomfort. It may also decrease morbidity, postoperative hospital length of stay and, thus, cost. Achieving optimal pain relief after cardiac surgery is often difficult. Many techniques are available, and all have specific advantages and disadvantages. Intrathecal and epidural techniques clearly produce reliable analgesia in patients undergoing cardiac surgery. Additional potential benefits include stress response attenuation and thoracic cardiac sympathectomy. The quality of analgesia obtained with thoracic epidural anesthetic techniques is sufficient to allow cardiac surgery to be performed in awake patients without general endotracheal anesthesia. However, applying regional anesthetic techniques to patients undergoing cardiac surgery is not without risk. Side effects of local anesthetics (hypotension) and opioids (pruritus, nausea/vomiting, urinary retention, and respiratory depression), when used in this manner, may complicate perioperative management. Increased risk of hematoma formation in this scenario has generated much of lively debate regarding the acceptable risk-benefit ratio of applying regional anesthetic techniques to patients undergoing cardiac surgery.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.