title: High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study.
abstract: BACKGROUND
  Thoracic epidural anesthesia (TEA) has been proposed to improve and facilitate early postoperative outcome in cardiac surgery. The aim of our study was to analyze early postoperative outcome data of patients undergoing cardiac surgery under general anesthesia (GA) with comparison to patients receiving combined TEA and GA.
  
  
  METHODS
  Medical records data from 288 patients who underwent elective on-pump cardiac surgery were retrieved and analyzed. Patients were divided into two study groups according to the type of anesthesia used: GA group (n = 141) and TEA group (n = 147). Early postoperative outcome data including quality of analgesia and major organ outcome parameters were compared between the study groups.
  
  
  RESULTS
  There was no major difference in early postoperative outcome data between the study groups, except for shorter time to extubation (6.0 ± 10.0 vs. 6.9 ± 8.8 h, respectively, P < 0.05) and hospital stay (10.7 ± 5.9 vs. 12.9 ± 8.8 days, respectively, P < 0.05) in TEA group compared to GA group. Also TEA group as compared to GA group had lower pain numeric rating scale scores (1 ± 1.1 vs. 1.4 ± 1.5 at 24 h, respectively, P < 0.05) and morphine requirements during the first 24 h after surgery (148.2 vs. 193 ± 85.4 μg/kg, respectively, P < 0.05).
  
  
  CONCLUSIONS
  Both anesthetic methods were equivalent in most postoperative outcome measures. Thoracic epidural analgesia provided superior pain relief, shorter time to extubation and earlier hospital discharge.
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Porizka
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
authors.forename: Katerina
authors.initials: K
authors.lastname: Koudelkova
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kopecky
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Porizkova
authors.affiliation: Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00 Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Dohnalova
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Kunstyr
keywords: Cardiac surgical procedure; Epidural anesthesia; Patient outcome assessment