title: [Cardioprotection by thoracic epidural anesthesia? : meta-analysis].
abstract: BACKGROUND
  Thoracic epidural analgesia (EDA) is thought to provide cardioprotective effects in patients undergoing noncardiac surgery. The results of two previous meta-analysis showed controversial conclusions regarding the impact of EDA on perioperative survival. The purpose of the present meta-analysis was to evaluate, whether thoracic EDA has the potential to reduce perioperative cardiac morbidity or mortality on the basis of available randomized controlled trials.
  
  
  METHODS
  A systematic literature search was conducted in medical databases (Med-Line, EBM-Reviews, Embase, Biosis and Biological Abstracts) and relevant clinical trials including patients undergoing noncardiac surgery were evaluated by two independent investigators. All randomized controlled trials investigating the effects of thoracic EDA on perioperative outcome, published from 1980 up to the end of 2008 were included into this quantitative systematic review. Calculations were performed using the statistics program Review Manager 4.1 using a fixed-effects model.
  
  
  RESULTS
  Nine studies with a total of 2,768 patients were included in the meta-analysis. Thoracic EDA did not reduce perioperative mortality [odds ratio (Peto OR): 1.08; 95% confidence interval (CI) 0.74-1.58]. Patients receiving thoracic EDA demonstrated a tendency to a lower rate of perioperative myocardial infarction. However, this effect of thoracic EDA did not reach statistical significance (Peto OR: 0.65; 95% CI 0.4-1.05).
  
  
  CONCLUSIONS
  The present meta-analysis did not prove any positive influence of thoracic EDA on perioperative in-hospital mortality in patients undergoing noncardiac surgery. Furthermore, it remains questionable if thoracic EDA has the potential to reduce the rate of perioperative myocardial infarction.
authors: Klinik für Anästhesiologie, Universitätsklinikum Ulm, Deutschland. albrecht.gauss@uniklinik-ulm.de
authors: A
authors: A
authors: Gauss
authors: S K
authors: SK
authors: Jahn
authors: L H J
authors: LH
authors: Eberhart
authors: W
authors: W
authors: Stahl
authors: M
authors: M
authors: Rockemann
authors: M
authors: M
authors: Georgieff
authors: F
authors: F
authors: Wagner
authors: R
authors: R
authors: Meierhenrich
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects; D000768:Anesthesia, General; D003627:Data Interpretation, Statistical; D006331:Heart Diseases / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome