title: Thoracic epidurals in heart valve surgery: neurologic risk evaluation.
abstract: 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).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  General reference hospital associated with a university.
  
  
  METHODS
  Patients (n = 305) who had surgery for replacement or repair of heart valves.
  
  
  METHODS
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Hospital General de Alicante, Alicante, Spain. m.canto@telefonica.net
authors.forename: Miguel
authors.initials: M
authors.lastname: Cantó
authors.forename: Angeles
authors.initials: A
authors.lastname: Casas
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Ana
authors.initials: A
authors.lastname: Lorenzo
authors.forename: Luisa
authors.initials: L
authors.lastname: Bataller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006407:Hematoma, Epidural, Cranial / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000209:etiology; D013129:Spinal Puncture / Q000009:adverse effects