Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .
The effects of epidural anesthesia on the neuroendocrine response to major surgical stress: a randomized prospective trial.
It has long been held that the acute-phase and neuroendocrine response to stress requires afferent neural input for its propagation . To further clarify the role of afferent neural impulses in this process and to determine the ability of epidural anesthesia to attenuate the normal perioperative stress response , 39 patients undergoing uncomplicated abdominal aortic replacement were r and omized to receive either general anesthesia with postoperative patient-controlled intravenous morphine ( n = 19 ) or combined regional/general anesthesia with intraoperative epidural catheter anesthesia using Bupivacaine to the T4 dermatome level followed by postoperative epidural morphine ( n = 20 ) . The stress response was quantitated by blinded measurement of baseline and postoperative ( 0 , 12 , 24 , 48 , and 72 hours ) serum cortisol , epinephrine norepinephrine , total catecholamines , interleukin (IL)-1beta , IL-6 , tumor necrosis factor (TNF)-alpha , and C-reactive protein ( CRP ) . Total operative time ( 4.2 + /- 0.3 vs 4.3 + /- 0.4 hours ) , 72-hour fluid requirement ( 7.0 + /- 0.6 vs 6.8 + /- 0.71 mL ) , and length of hospitalization ( 7.8 + /- 1.4 vs 8.1 + /- 1.2 days ) were not different between groups . All patients showed a significant increase in cortisol , epinephrine , norepinephrine , total catecholamines , CRP , and IL-6 in the postoperative period ( P < 0.05 ) . IL-1beta and TNF-alpha were less predictable and undetectable in most patients . There was no difference in any of the stress response indices between those patients receiving patient-controlled or epidural catheter anesthesia . In fact , the only parameter that was predictive of increased activation of the stress response was the length of operation , irrespective of anesthetic method . Those patients with operative times greater than 5 hours ( n = 10 ) developed significantly higher CRP , IL-1beta , IL-6 , and TNF-alpha levels ( P < 0.05 ) at 12 and 24 hours postoperatively than those with total operative times less than 4 hours ( n = 16 ) . The neuroendocrine response to major surgical stress is propagated normally despite epidural blockade and is intensified with prolonged operative times . The inflammatory cytokines appear to play a major role in this process
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .