The risk of vertebral canal complications in 2837 cardiac surgery patients with thoracic epidurals.
BACKGROUND
Recent communications in the medical press have suggested that the rate of vertebral canal complications following epidural catheter placement is increasing in frequency, in particular the incidence of epidural abscess (Hearn M. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2003; 90 (5): 706-7; Govasi C, Bland D, Poddar R, Horst C. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2004; 92 (2): 294-5). We wished to investigate this in our population of cardiac surgical patients.


METHODS
We performed a retrospective review of the data from all patients who had undergone coronary artery bypass grafting or valve replacement surgery in our hospital over the past 8 years. This involved a review of computer databases, logbooks, radiology records, admission records, intensive care transfers, pain team ward round data and follow-up outpatient data referrals.


RESULTS
In total, 2837 patient admissions were examined and reviewed by the authors. No episodes of vertebral canal haematoma or abscess were observed.


CONCLUSIONS
Retrospective analysis of our working practice indicates that thoracic epidural anaesthesia and analgesia are safe in patients receiving cardiac surgery. We found no epidural haematoma or abscess in 2837 patients.
Jack
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ES
Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, UK. ewanwendy@tiscali.co.uk
Scott
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NB
D000038:Abscess / Q000209:etiology / Q000382:microbiology; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology / Q000209:etiology*; D013203:Staphylococcal Infections / Q000209:etiology