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Opinions/Hypotheses |

Neuraxial Blockade and Hematoma in Cardiac Surgery*: Estimating the Risk of a Rare Adverse Event That Has Not (Yet) Occurred

Anthony M.-H. Ho, MD, MS; David C. Chung, MD; Gavin M. Joynt, MBBCh
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*From the Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.

Correspondence to: Anthony M.-H. Ho, MD, MS, Department of Anaesthesia and Intensive Care, The Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PRC; e-mail: hoamh@hotmail.com



Chest. 2000;117(2):551-555. doi:10.1378/chest.117.2.551
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Although neuraxial anesthesia and analgesia techniques are widely used in many branches of surgery, critical care, and chronic pain, they have not enjoyed great popularity in operations involving cardiopulmonary bypass (CPB). This is mainly because of a concern for neuraxial hematoma and spinal cord injury when large doses of heparin are used. There are, however, many potential advantages of epidural and spinal anesthesia and analgesia in cardiac surgery. There is evidence to support improved hemodynamic stability,14 intense analgesia,48 early tracheal extubation,56,9 improved pulmonary function,56 enhanced coronary perfusion,912 decreased ischemia,9 improved ventricular function,13 and improved metabolic profile.,1,3 Other advantages may include better pulmonary toilet, early ambulation, shorter ICU stay, and cost reduction. Sympathetic blockade may be particularly useful in minimally invasive cardiac surgery, although the possibility of unscheduled CPB remains a concern.

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