Epidural analgesia in cardiac surgery: an updated risk assessment.
BACKGROUND
The use of epidural anesthesia carries risks that have been known for 50 years. The debate about the use of locoregional technique in cardiac anesthesia continues. The objective of this report is to estimate the risks and their variability of a catheter-related epidural hematoma in cardiac surgery patients and to compare it with other anesthetic and medical procedures.


METHODS
Case series reporting the use of epidural anesthesia in cardiac surgery were researched through Medline. Additional references were retrieved from the bibliography of published articles and from the internet. Risks of complications in other anesthetic and medical activity were retrieved from recent reviews.


RESULTS
Based on the present evidence, the risk of epidural hematoma in cardiac surgery is 1:12,000 (95% CI of 1:2100 to 1:68,000), which is comparable to the risk in the nonobstetrical population of 1:10,000 (95% CI 1:6700 to 1:14,900). The risk of epidural hematoma is comparable to the risk of receiving a wrong blood product or the yearly risk of having a fatal road accident in Western countries.


CONCLUSIONS
The risk of a hematoma after epidural in cardiac surgery is comparable to other nonobstetrical surgical procedures. Its routine application in a controlled setting should be encouraged.
Bracco
David
D
Perioperative Cardiac Research Group (PeriCARG), Department of Anesthesiology, Montreal General Hospital, McGill University Health Center, Montreal, Québec, Canada. Bracco@McGill.Ca <Bracco@McGill.Ca>
Hemmerling
Thomas
T
D000767:Anesthesia, Epidural / Q000401:mortality*; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D046748:Hematoma, Epidural, Spinal / Q000401:mortality*; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013534:Survival; D015996:Survival Rate