JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tuman, K. J. Articles by Ivankovich, A. D. Search for Related Content PubMed PubMed Citation Articles by Tuman, K. J. Articles by Ivankovich, A. D.

Effects of Epidural Anesthesia and Analgesia on Coagulation and Outcome After Major Vascular Surgery

Departments of Anesthesiology and Cardiovascular Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois

Abstract

To examine the interaction of epidural anesthesia, coagulation status, and outcome after lower extremity revascularization, 80 patients with atherosclerotic vascular disease were prospectively randomized to receive general anesthesia combined with postoperative epidural analgesia (GEN-EPI) or general anesthesia with on-demand narcotic analgesia (GEN). Demographics did not differ between groups except that the GEN-EPI group had a higher incidence of diabetes mellitus and of previous myocardial infarction. Coagulation status was monitored using thromboelastography. An additional 40 randomly selected patients without atherosclerotic vascular disease undergoing noncardiovascular procedures served as controls for coagulation status. Vascular surgical patients were hypercoagulable compared with control patients before operation and on the first postoperative day. Postoperatively, this hypercoagulability was attenuated in the GEN-EPI group and was associated with a lower incidence of thrombotic events (peripheral arterial graft, coronary artery or deep vein thromboses). The rates of cardiovascular, infectious, and overall postoperative complications, as well as duration of intensive care unit stay, were significantly reduced in the GEN-EPI group. Stepwise logistic regression demonstrated that the only significant predictors of postoperative cardiovascular complications were preoperative congestive heart failure and general anesthesia without epidural analgesia. We conclude that in patients with atherosclerotic vascular disease undergoing arterial reconstructive surgery (a) thromboelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and (b) epidural anesthesia and analgesia is associated with beneficial effects on coagulation status and postoperative outcome compared with intermittent on-demand opioid analgesia.

This article has been cited by other articles:

				Y. Dai, A. Lee, L. A. H. Critchley, and P. F. White Does Thromboelastography Predict Postoperative Thromboembolic Events? A Systematic Review of the Literature Anesth. Analg., March 1, 2009; 108(3): 734 - 742. [Abstract] [Full Text] [PDF]

				D. M. Popping, N. Elia, E. Marret, C. Remy, and M. R. Tramer Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery: A Meta-Analysis Arch Surg, October 1, 2008; 143(10): 990 - 999. [Abstract] [Full Text] [PDF]

				R. Christopherson, K. E. James, M. Tableman, P. Marshall, and F. E. Johnson Long-Term Survival After Colon Cancer Surgery: A Variation Associated with Choice of Anesthesia Anesth. Analg., July 1, 2008; 107(1): 325 - 332. [Abstract] [Full Text] [PDF]

				L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]

				L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]

				I. Cattabriga, D. Pacini, G. Lamazza, F. Talarico, R. Di Bartolomeo, G. Grillone, and L. Bacchi-Reggiani Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 527 - 531. [Abstract] [Full Text] [PDF]

				D. L. Reich and G. W. Fischer Perioperative Interventions to Modify Risk of Morbidity and Mortality Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2007; 11(3): 224 - 230. [Abstract] [PDF]

				M. A. Chaney Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery Anesth. Analg., January 1, 2006; 102(1): 45 - 64. [Abstract] [Full Text] [PDF]

				E. R. Viscusi Emerging Techniques in the Management of Acute Pain: Epidural Analgesia Anesth. Analg., November 1, 2005; 101(5S_Suppl): S23 - 29. [Abstract] [Full Text] [PDF]

				R. Poston, J. Gu, J. Manchio, A. Lee, J. Brown, J. Gammie, C. White, and B. P. Griffith Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 584 - 591. [Abstract] [Full Text] [PDF]

				J. N. Ghansah and J. T. Murphy Complications of Major Aortic and Lower Extremity Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 335 - 361. [Abstract] [PDF]

				A. Kulik, M. Ruel, M. E. Bourke, L. Sawyer, J. Penning, H. J. Nathan, T. G. Mesana, and P. Bedard Postoperative naproxen after coronary artery bypass surgery: a double-blind randomized controlled trial Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 694 - 700. [Abstract] [Full Text] [PDF]

				B. A. Perler A Comparison of Intrathecal Opioid and Intravenous Analgesia for the Incidence of Cardiovascular, Respiratory, and Renal Complications after Abdominal Aortic Surgery Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2004; 16(2): 146 - 147. [Abstract] [PDF]

				T. T. Horlocker Regional Anesthesia and Anticoagulation in Patients undergoing Cardiothoracic and Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 417 - 426. [Abstract] [PDF]

				S. H. Wilson, P. Fasseas, J. L. Orford, R. J. Lennon, T. Horlocker, N. E. Charnoff, S. Melby, and P. B. Berger Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting J. Am. Coll. Cardiol., July 16, 2003; 42(2): 234 - 240. [Abstract] [Full Text] [PDF]

				M.-H. Fleron, R. B. Weiskopf, M. Bertrand, S. Mouren, D. Eyraud, G. Godet, B. Riou, E. Kieffer, and P. Coriat A Comparison of Intrathecal Opioid and Intravenous Analgesia for the Incidence of Cardiovascular, Respiratory, and Renal Complications After Abdominal Aortic Surgery Anesth. Analg., July 1, 2003; 97(1): 2 - 12. [Abstract] [Full Text] [PDF]

				D. J. Cook and G. A. Rooke Priorities in Perioperative Geriatrics Anesth. Analg., June 1, 2003; 96(6): 1823 - 1836. [Full Text] [PDF]

				R. Schumann, S. Shikora, J. M. Weiss, H. Wurm, S. Strassels, and D. B. Carr A Comparison of Multimodal Perioperative Analgesia to Epidural Pain Management After Gastric Bypass Surgery Anesth. Analg., February 1, 2003; 96(2): 469 - 474. [Abstract] [Full Text] [PDF]

				M. S. Kashyap, S. S. Ahn, W. J. Quinones-Baldrich, B.-U. Choi, F. Dorey, T. D. Reil, J. A. Freischlag, and W. S. Moore Infrapopliteal-Lower Extremity Revascularization with Prosthetic Conduit: A 20-Year Experience Vascular and Endovascular Surgery, July 1, 2002; 36(4): 255 - 262. [Abstract] [PDF]

				K. Hahnenkamp, G. Theilmeier, H. K. Van Aken, and C. W. Hoenemann The Effects of Local Anesthetics on Perioperative Coagulation, Inflammation, and Microcirculation Anesth. Analg., June 1, 2002; 94(6): 1441 - 1447. [Full Text] [PDF]

				R. Ehlers, T. W. Felbinger, H. K. Eltzschig, L. A. Fleisher, and K. A. Eagle Lowering Cardiac Risk in Noncardiac Surgery N. Engl. J. Med., April 4, 2002; 346(14): 1096 - 1097. [Full Text] [PDF]

				W. S. Beattie, N. H. Badner, and P. Choi Epidural Analgesia Reduces Postoperative Myocardial Infarction: A Meta-Analysis Anesth. Analg., October 1, 2001; 93(4): 853 - 858. [Abstract] [Full Text] [PDF]

				J. Boldt, I. Huttner, St. Suttner, B. Kumle, S. N. Piper, and G. Berchthold Changes of haemostasis in patients undergoing major abdominal surgery--is there a difference between elderly and younger patients? Br. J. Anaesth., September 1, 2001; 87(3): 435 - 440. [Abstract] [Full Text] [PDF]

				C. J. O'Connor and K. J. Tuman Epidural Anesthesia and Analgesia for Coronary Artery Bypass Graft Surgery: Still Forbidden Territory? Anesth. Analg., September 1, 2001; 93(3): 523 - 525. [Full Text] [PDF]

				H. Kehlet and K. Holte Effect of postoperative analgesia on surgical outcome Br. J. Anaesth., July 1, 2001; 87(1): 62 - 72. [Abstract] [Full Text] [PDF]

				C. M. Samama Thromboelastography: The Next Step Anesth. Analg., March 1, 2001; 92(3): 563 - 564. [Full Text] [PDF]

				E. Mahla, T. Lang, M. N. Vicenzi, G. Werkgartner, R. Maier, C. Probst, and H. Metzler Thromboelastography for Monitoring Prolonged Hypercoagulability After Major Abdominal Surgery Anesth. Analg., March 1, 2001; 92(3): 572 - 577. [Abstract] [Full Text] [PDF]

				S. A. Bew, A. E. Bryant, J. P. Desborough, and G. M. Hall Epidural analgesia and arterial reconstructive surgery to the leg: effects on fibrinolysis and platelet degranulation Br. J. Anaesth., February 1, 2001; 86(2): 230 - 235. [Abstract] [Full Text] [PDF]

				A. Rodgers, N. Walker, S Schug, A McKee, H Kehlet, A van Zundert, D Sage, M Futter, G Saville, T Clark, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials BMJ, December 16, 2000; 321(7275): 1493 - 1493. [Abstract] [Full Text]

				S. Mantha Rational Cardiac Risk Stratification Before Peripheral Vascular Surgery: Application of Evidence-Based Medicine and Bayesian Analysis Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2000; 4(4): 198 - 212. [PDF]

				C. L. Wu and L. A. Fleisher Outcomes Research in Regional Anesthesia and Analgesia Anesth. Analg., October 1, 2000; 91(5): 1232 - 1242. [Full Text] [PDF]

				J. P. Desborough The stress response to trauma and surgery Br. J. Anaesth., July 1, 2000; 85(1): 109 - 117. [Full Text] [PDF]

				M. K. Urban, S. M. Markowitz, M. A. Gordon, B. L. Urquhart, and P. Kligfield Postoperative Prophylactic Administration of {beta}-Adrenergic Blockers in Patients at Risk for Myocardial Ischemia Anesth. Analg., June 1, 2000; 90(6): 1257 - 1261. [Abstract] [Full Text] [PDF]

				G. B. Hammer, K. Ngo, and A. Macario A Retrospective Examination of Regional Plus General Anesthesia in Children Undergoing Open Heart Surgery Anesth. Analg., May 1, 2000; 90(5): 1020 - 1024. [Abstract] [Full Text] [PDF]

				K. J. Tuman Cardiovascular Anesthesiology in the 1990s and Beyond Anesth. Analg., May 1, 2000; 90(5): 1229 - 1231. [Full Text] [PDF]

				R. A. Kahn Pain Management After Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1999; 3(3): 177 - 181. [Abstract] [PDF]

				J. G. Ramsay Cardiac Management in the ICU Chest, May 1, 1999; 115(suppl_2): 138S - 144S. [Abstract] [Full Text] [PDF]

				S. Datta and S. Jain Pain Management Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1997; 1(3): 264 - 277. [Abstract] [PDF]

				S. Howell and P. Foex Stratifying patients by perioperative risk is equivalent to screening BMJ, September 21, 1996; 313(7059): 750a - 750. [Full Text]

				D. A. O'Hara and L. G. Kushins Preoperative Prediction of Postoperative Delirium JAMA, May 25, 1994; 271(20): 1573 - 1573. [Abstract] [PDF]

				H. W. Hopf and S. Weitz Postoperative Pain Management Arch Surg, February 1, 1994; 129(2): 128 - 132. [Abstract] [PDF]

				Q. Hogan The Cardiac Risks of Noncardiac Surgery JAMA, April 28, 1993; 269(16): 2083 - 2083. [Abstract] [PDF]

				P. Barash Anesthesiology JAMA, July 15, 1992; 268(3): 335 - 337. [Abstract] [PDF]

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