: 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 Analgesia and Intravenous Patient-Controlled Analgesia Result in Similar Rates of Postoperative Myocardial Ischemia After Aortic Surgery
To assess the role of postoperative analgesia on  myocardial ischemia after aortic surgery , we compared intravenous patient-controlled analgesia ( PCA ) with thoracic epidural analgesia ( TEA ) .  One hundred twenty-four patients were prospect ively r and omized to the PCA or TEA group . In the TEA group , a T6 - 7 or T7 - 8 epidural catheter was inserted before the induction of general anesthesia . Within 1 h of the end of surgery , analgesia and 24-h two-channel Holter monitoring were begun . Myocardial ischemia was defined as ST segment depression > or = to1 mm , 0.06 s after the J point , and lasting for more than 1 min . In the PCA group , a bolus of morphine , 0.05 mg/kg , was given , followed by 0.02 mg/kg of morphine on dem and every 10 min . Bupivacaine 0.125 % and fentanyl 10 micro g/mL was used in the TEA group . Analgesics were titrated to maintain a visual analog scale score < or = to3 . The overall incidence of myocardial ischemia was 18.4%-18.2 % for TEA and 18.6 % for PCA ( P = not significant ) . There were no differences between the groups in the total duration of ischemia per patient ( 22.2 + /- 119.8 min for TEA and 20.5 + /- 99 min for PCA ) and the number of episodes per patient ( 0.69 + /- 2.1 for TEA and 1.2 + /- 4.9 for PCA ) . Twenty-three patients had an adverse cardiac outcome , although there were no differences between the groups . The postoperative pain control was superior with TEA . In these patients undergoing elective aortic surgery , the use of postoperative TEA did not result in a lower incidence of early myocardial ischemia compared with intravenous PCA with morphine , despite better analgesia with TEA . Implication s : Postoperative myocardial ischemia is associated with adverse cardiac outcome . Using Holter monitoring after aortic surgery , this study shows that the use of thoracic epidural analgesia with bupivacaine and fentanyl did not result in a lower incidence of myocardial ischemia compared with intravenous patient-controlled analgesia with morphine . ( Anesth Analg 1997;85:1233 - 9
: 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 .