Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery.
BACKGROUND
A combination of general anesthesia (GA) with thoracic epidural anesthesia (TEA) may have a beneficial effect on clinical outcomes after cardiac surgery. We have performed a meta-analysis to compare mortality and cardiac, respiratory, and neurologic complications in patients undergoing cardiac surgery with GA alone or a combination of GA with TEA.


METHODS
Randomized studies comparing outcomes in patients undergoing cardiac surgery with either GA alone or GA in combination with TEA were retrieved from PubMed, Science Citation index, EMBASE, CINHAL, and Central Cochrane Controlled Trial Register databases.


RESULTS
The search strategy yielded 1,390 studies; 28 studies that included 2,731 patients met the selection criteria. Compared with GA alone, the combined risk ratio for patients receiving GA with TEA was 0.81 (95% CI: 0.40-1.64) for mortality, 0.80 (95% CI: 0.52-1.24) for myocardial infarction, and 0.59 (95% CI: 0.24-1.46) for stroke. The risk ratios for the respiratory complications and supraventricular arrhythmias were 0.53 (95% CI: 0.40-0.69) and 0.68 (95% CI: 0.50-0.93), respectively.


CONCLUSIONS
This meta-analysis showed that the use of TEA in patients undergoing cardiac surgery reduces the risk of postoperative supraventricular arrhythmias and respiratory complications. The sparsity of events precludes conclusions about mortality, myocardial infarction, and stroke, but the estimates suggest a reduced risk after TEA. The risk of side effects of TEA, including epidural hematoma, could not be assessed with the current dataset, and therefore TEA should be used with caution until its benefit-harm profile is further elucidated.
Anesthesiology Resident, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands. v.svircevic@umcutrecht.nl
Vesna
V
Svircevic
Diederik
D
van Dijk
Arno P
AP
Nierich
Martijn P
MP
Passier
Cor J
CJ
Kalkman
Geert J M G
GJ
van der Heijden
Leon
L
Bax
D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013904:Thoracic Vertebrae