Regional Anesthesia in Cardiac Surgery: A Friend or A Foe?
Regional Anesthesia in Cardiac Surgery: A Friend or A Foe?
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DOI：
10.1177/108925320500900109
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发表时间：
2005-03-01
影响因子：
1.4
通讯作者：
Beattie, W. Scott
中科院分区：
文献类型：
--
作者：
Djaiani, George;Fedorko, Ludwik;Beattie, W. Scott
不断上升的成本和心脏手术患者的特征变化需要修改围手术期管理策略。区域麻醉在北美和欧洲的许多快速通道麻醉方案中发挥了不可或缺的作用。这篇综述表明，对于接受冠状动脉旁路移植术的患者，硬膜外麻醉和脊髓麻醉的风险受益比是有利的，前提是没有特定的禁忌症，并遵循心脏手术中使用区域技术的指南。区域技术管理的患者似乎受益于上级术后镇痛，术后通气时间更短，室上性心律失常的发生率降低，围手术期心肌梗死的发生率更低。本分析的结果表明，对于每一次神经系统并发症，可以预防20次心肌梗死和76次心房颤动，因此，我们认为区域麻醉和镇痛是改善围手术期发病率的有效策略。然而，其他治疗方式，如添加钙通道阻滞剂，阿司匹林和心脏不停跳手术，也被认为是有益的心脏手术患者，并可能比使用区域技术的风险更小。我们认为，这次审查的结果令人鼓舞，足以允许继续调查。一项前瞻性、随机、对照的多中心试验需要有足够的把握度来回答重要的临床问题，并允许长期随访。
Escalating costs and change in the profile of patients presenting for cardiac surgery requires modification of perioperative management strategies. Regional anesthesia has played an integral part of many fast-track anesthesia protocols across North America and Europe. This review suggests that for patients undergoing coronary artery bypass graft surgery, the risk-to-benefit ratio is in favor of epidural and spinal anesthesia, provided there are no specific contraindications and the guidelines for the use of regional techniques in cardiac surgery are followed. Patients managed with regional techniques seem to benefit from superior postoperative analgesia, shorter postoperative ventilation, reduced incidence of supraventricular arrhythmia, and lower rates of perioperative myocardial infarction. The results of this analysis suggest that for each episode of neurologic complication, 20 myocardial infarctions and 76 episodes of atrial fibrillation would be prevented, thus, we would consider the regional anesthesia and analgesia to be an effective strategy that improves perioperative morbidity. However, other treatment modalities such as the addition of calcium channel blockers, aspirin, and beating heart surgery, are also suggested to be beneficial in cardiac surgical patients and may impose less risk than the use of regional techniques. We believe that the results presented in this review are encouraging enough to permit continued investigation. A prospective, randomized, controlled multicenter trial needs to be adequately powered to answer important clinical questions and allow for a long-term follow-up.