: Compared with general anesthesia , neuraxial anesthesia may reduce the 0-to-30-day mortality for patients undergoing a surgery with an intermediate-to-high cardiac risk ( level of evidence moderate ) .
BACKGROUND : This analysis summarized Cochrane review s that assess the effects of neuraxial anesthesia on perioperative rates of death , chest infections , and myocardial infa rct ion .
Epidural Bupivacaine-Morphine Analgesia versus Patient-controlled Analgesia following Abdominal Aortic Surgery: Analgesic, Respiratory, and Myocardial Effects
Background The efficacy and effects of epidural analgesia compared with patient-controlled analgesia ( PCA ) have not been reported in patients undergoing major vascular surgery . We compared the effects of epidural bupivacaine-morphine with those of intravenous PCA morphine  after elective infrarenal aortic surgery . Methods Forty patients classified as American Society of Anesthesiologists physical status 2 or 3 received  general anesthesia plus postoperative PCA using morphine sulfate ( group PCA ; n = 21 ) or general anesthesia plus perioperative epidural morphine - bupivacaine ( group EPI ; n = 19 ) during a period of 48 h. During operation , EPI patients received 0.05 mg/kg epidural morphine and 5 ml 0.25 % bupivacaine followed by an infusion of 0.125 % bupivacaine with 0.1 % morphine ( 0.1 mg/ml ) ; group PCA received 0.1 mg/kg intravenous morphine sulfate .  Continuous electrocardiographic monitoring ( V4 and V5 leads ) was performed from the night before surgery until 48 h afterward . Respiratory inductive plethysmographic data were recorded after tracheal extubation . Visual analog pain scores at rest and after movement were performed every 4 h after extubation . Results Nurse-administered intravenous morphine  and time to tracheal extubation were less in group EPI , as were visual analog pain scores at rest and after movement from 20 to 48 h. Complications and the duration of intensive care unit and hospital stay were comparable . There was a similar , low incidence of postoperative apneas , slow respiratory rates , desaturation , and S-T segment depression . Conclusions Epidural morphine-bupivacaine is associated with reduced early postoperative intravenous opioid requirements , more rapid tracheal extubation , and superior analgesia after abdominal aortic surgery , with comparable respiratory effects
: Compared with general anesthesia , neuraxial anesthesia may reduce the 0-to-30-day mortality for patients undergoing a surgery with an intermediate-to-high cardiac risk ( level of evidence moderate ) .
BACKGROUND : This analysis summarized Cochrane review s that assess the effects of neuraxial anesthesia on perioperative rates of death , chest infections , and myocardial infa rct ion .