Epidural catheterization in cardiac surgery: The 2012 risk assessment.
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Date
2013-07
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Abstract
Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552). Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.
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Keywords
Epidural anesthesia, Epidural catheter, Epidural hematoma, High thoracic anesthesia, Risk assessment
Citation
Hemmerling Thomas M, Cyr Shantale, Terrasini Nora. Epidural catheterization in cardiac surgery: The 2012 risk assessment. Annals of Cardiac Anaesthesia. 2013 Jul; 16(3): 169-177.