Thoracic epidurals in heart valve surgery: neurologic risk evaluation.

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.