Thoracic Epidural Anesthesia and Cardiac Surgery: Balancing Postoperative Risks Associated With Hematoma Formation and Thromboembolic Phenomenon

摘要

Utilization of intrathecal and epidural anesthesia and analgesia techniques in patients undergoing cardiac surgery has increased. Potential benefits include improved postoperative analgesia, attenuation of the stress response to surgery, and induction of thoracic cardiac sympathectomy. These potential clinical benefits may reduce perioperative morbidity and mortality. However, substantial controversy persists regarding the safety of intrathecal and epidural instrumentation in cardiac surgical patients who subsequently receive perioperative anticoagulation therapy. Risk for hematoma formation in this scenario is certainly increased (degree unknown). A less apparent risk for thromboembolic phenomenon may also be increased via iatrogenic alterations in level of anticoagulation. The present case report highlights such risk. The perioperative course in a patient who underwent cardiac surgery with thoracic epidural supplementation and experienced a thromboembolic phenomenon during the postoperative period when normalization of coagulation parameters was achieved to safely remove the thoracic epidural catheter is described.