EPIDURAL-ANESTHESIA IN CARDIAC-SURGERY - IS THERE AN INCREASED RISK

Objective: To assess the risk of hemorrhagic complications associated with epidural anesthesia in patients undergoing coronary artery bypass grafting. Design: A prospective study. Setting: A cardiac surgical ce nter associated with a university. Participants: Five hundred fifty-ei ght consecutive patients scheduled for coronary artery bypass surgery. Interventions: A Tuohy 18G epidural catheter was inserted the day bef ore surgery in all patients. Measurements and Main Results: Preoperati ve coagulation tests, such as platelet count and prothrombin time, wer e performed. No patient was on oral anticoagulation therapy or had coa gulation disorders. Four hundred three (72%) patients were on antiplat elet therapy, which was terminated at least 1 week before surgery. The epidural catheter was left in situ for up to 5 days. All patients wer e observed daily for signs of spinal cord compromise, such as radicula r back pain or progressive sensory or motor deficits. There were no do cumented spinal hematomas. Conclusion: By following certain guidelines , the risk for the development of epidural hematoma is not increased i n patients undergoing epidural anesthesia during cardiac surgery. Copy right (C) 1998 by W.B. Saunders Company.