title: Epidural anesthesia in cardiac surgery: is there an increased risk?
abstract: OBJECTIVE
  To assess the risk of hemorrhagic complications associated with epidural anesthesia in patients undergoing coronary artery bypass grafting.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  A cardiac surgical center associated with a university.
  
  
  METHODS
  Five hundred fifty-eight consecutive patients scheduled for coronary artery bypass surgery.
  
  
  METHODS
  A Tuohy 18G epidural catheter was inserted the day before surgery in all patients.
  
  
  RESULTS
  Preoperative coagulation tests, such as platelet count and prothrombin time, were performed. No patient was on oral anticoagulation therapy or had coagulation disorders. Four hundred three (72%) patients were on antiplatelet therapy, which was terminated at least 1 week before surgery. The epidural catheter was left in situ for up to 5 days. All patients were observed daily for signs of spinal cord compromise, such as radicular back pain or progressive sensory or motor deficits. There were no documented spinal hematomas.
  
  
  CONCLUSIONS
  By following certain guidelines, the risk for the development of epidural hematoma is not increased in patients undergoing epidural anesthesia during cardiac surgery.
authors.affiliation: Department of Cardiothoracic Anesthesia, Copenhagen Heart Center, Hellerup, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Sanchez
authors.forename: E
authors.initials: E
authors.lastname: Nygård
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology