High thoracic epidural anesthesia and coronary artery disease in surgical and non-surgical patients

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Abstract

Purpose of review

Even though high thoracic epidural anesthesia has been shown to be highly efficacious in the control of symptoms in refractory angina, its general use is still restricted. In patients who undergo coronary revascularization, however, the technique is becoming more and more popular. The present review outlines the use of high thoracic epidural anesthesia in patients with ischemic heart disease who underwent coronary revascularization in order to further reveal high thoracic epidural anesthesia's low complication rate and to analyze why physicians still refrain from using it more frequently.

Recent findings

The incidence of severe hemodynamic complications after high thoracic epidural anesthesia is low in patients with coronary artery disease. The main advantage would be a myocardial sympathectomy leading to an improvement in the oxygen input–demand relationship. Likewise, a decrease in mortality due to respiratory complications could not be shown. In patients undergoing myocardial revascularization with full anticoagulation there is an increased risk of epidural hematoma formation. Its precise risk is difficult to evaluate. There is an overall low rate of epidural hematomas as a result of high thoracic epidural anesthesia. With the available data, the incidence has been estimated at between 1/1500 and 1/10 000.

Summary

Epidural anesthesia does not decrease mortality or the incidence of myocardial infarction after coronary artery bypass grafting. It reduces the incidence of arrhythmias and respiratory complications and improves the quality of analgesia. High thoracic epidural anesthesia has been shown to be a safe and efficient technique for refractory angina that reduces the frequency of ischemic events and improves the clinical condition of patients.

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