Epidural analgesia in cardiac surgery: An updated risk assessment
Epidural analgesia in cardiac surgery: An updated risk assessment
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DOI：
10.1532/hsf98.20071077
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发表时间：
2007-08-01
影响因子：
0.6
通讯作者：
Hemmerling, Thomas
中科院分区：
文献类型：
--
作者：
Bracco, David;Hemmerling, Thomas
导论.硬膜外麻醉的使用带来的风险已经被知道了50年。关于局部技术在心脏麻醉中的应用的争论仍在继续。本报告的目的是评估心脏手术患者导管相关硬膜外血肿的风险及其变异性，并将其与其他麻醉和医疗程序进行比较。通过Medline研究了报告心脏手术中使用硬膜外麻醉的病例系列。从已发表文章的参考书目和互联网中检索其他参考文献。从最近的综述中检索其他麻醉和医疗活动中的并发症风险。根据现有证据，心脏手术中硬膜外血肿的风险为1：12，000（95% CI为1：2100至1：68，000），与非产科人群中的风险1：10，000（95% CI为1：6700至1：14，900）相当。硬膜外血肿的风险与接受错误血液制品的风险或西方国家每年发生致命交通事故的风险相当。心脏手术硬膜外术后血肿的风险与其他非产科手术相当。应鼓励在有控制的环境中例行使用这种方法。
Introduction. The use of epidural anesthesia carries risks that have been known for 50 years. The debate about the use of locoregional technique in cardiac anesthesia continues. The objective of this report is to estimate the risks and their variability of a catheter-related epidural hematoma in cardiac surgery patients and to compare it with other anesthetic and medical procedures.Methods. Case series reporting the use of epidural anesthesia in cardiac surgery were researched through Medline. Additional references were retrieved from the bibliography of published articles and from the internet. Risks of complications in other anesthetic and medical activity were retrieved from recent reviews.Results. Based on the present evidence, the risk of epidural hematoma in cardiac surgery is 1:12,000 (95% CI of 1:2100 to 1:68,000), which is comparable to the risk in the nonobstetrical population of 1:10,000 (95% CI 1:6700 to 1:14,900). The risk of epidural hematoma is comparable to the risk of receiving a wrong blood product or the yearly risk of having a fatal road accident in Western countries.Conclusions. The risk of a hematoma after epidural in cardiac surgery is comparable to other nonobstetrical surgical procedures. Its routine application in a controlled setting should be encouraged.