[Ischemia, myocardial infarction and epidural anesthesia in patients with coronary disease].
In patients with coronary artery disease, the beneficial effects of epidural anesthesia are well known and often emphasized. Thus, several studies have shown a decrease in the determinants of myocardial oxygen consumption, and an improvement in regional and global left ventricular performance. The disadvantages of epidural anesthesia in patients with coronary artery disease are also well known, however, rarely reported. These detrimental effects are dominated by a decrease in arterial pressure which in turn may compromise the coronary perfusion pressure and induce myocardial ischemia. These 2 case reports illustrate the occurrence of myocardial complications in relation to epidural anesthesia. These case reports contrast with data from the literature showing a beneficial influence of epidural anesthesia on the myocardium. However, the severity of the coronary artery disease in these 2 reported patients may explain this discrepancy. These case reports pointed out that the decrease in arterial pressure is not the exclusive mechanism by which myocardial ischemia may be observed during epidural anesthesia since an hemodynamically-unrelated ischemic episode is described. The treatment of myocardial ischemia during epidural anesthesia is illustrated by these 2 case reports. A relationship between myocardial ischemia and myocardial infarction is discussed from these observations.
Mion
G
G
Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris.
Baron
J F
JF
Mouren
S
S
Viars
P
P
D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D003327:Coronary Disease / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000209:etiology*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*
Ischémie, infarctus myocardique et anesthésie péridurale chez le coronarien.