| Thoracic epidurals in heart valve surgery: neurologic risk evaluation. | |
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MedLine Citation:
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PMID: 12486653 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the risk of neurologic complications resulting from epidural hematoma in a series of patients who had surgery for repair or replacement of heart valves under combined general and thoracic epidural anesthesia (TEA). DESIGN: Prospective observational study. SETTING: General reference hospital associated with a university. PARTICIPANTS: Patients (n = 305) who had surgery for replacement or repair of heart valves. INTERVENTIONS: An epidural catheter was inserted at T1-3 as soon as the patient was in the operating room, and local anesthetic was administered as a bolus, then as a continuous infusion throughout the operation and postoperatively. A protocol for postoperative neurologic evaluation was used to rule out clinical signs of spinal lesions. A set of safety guidelines was routinely followed. MEASUREMENTS AND MAIN RESULTS: Preoperatively a battery of coagulation tests was systematically carried out: activated partial thromboplastin time, platelet count, and prothrombin time. Oral anticoagulants (warfarin) were stopped >60 hours before surgery, and antiplatelet drugs (aspirin) were stopped 7 days before. No patient required parenteral opiates postoperatively. Of the patients, 65% were extubated in the operating room. There were no neurologic complications resulting from epidural hematoma. CONCLUSION: TEA can provide effective postoperative analgesia and assist in early tracheal extubation in cardiac valve surgery. In this series, there were no neurologic deficits detected. When certain safety measures are taken, routine TEA is feasible and helpful in cardiac valve surgery. |
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Authors:
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Miguel Cantó; Angeles Casas; Maria J Sánchez; Ana Lorenzo; Luisa Bataller |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 16 ISSN: 1053-0770 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 2002 Dec |
Date Detail:
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Created Date: 2002-12-17 Completed Date: 2003-04-02 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 723-6 Citation Subset: IM |
Copyright Information:
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Copyright 2002, Elsevier Science (USA). All rights reserved. |
Affiliation:
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Department of Anesthesiology, Hospital General de Alicante, Alicante, Spain. m.canto@telefonica.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anesthesia, Epidural / adverse effects* Anesthesia, General Female Heart Valves / surgery* Hematoma, Epidural, Cranial / etiology* Humans Male Middle Aged Prospective Studies Risk Factors Spinal Cord Injuries / etiology Spinal Puncture / adverse effects |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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