Thoracic epidural anesthesia in on-pump cardiac surgery carries concerns for neuraxial hematoma and spinal cord injury due to required anticoagulation and frequent antiplatelet use.
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Supports caution with thoracic epidural anesthesia in on-pump cardiac surgery; leaves open prospective safety evaluation.
Thoracic epidural anaesthesia (TEA) is not widely used in patients undergoing on-pump cardiac surgery. The main concern is the risk of neuraxial haematoma and spinal cord injury associated with epidural instrumentation and subsequent anticoagulation for cardiopulmonary bypass (CPB). Cardiac patients are often on aspirin and other antiplatelet agents which may further increase this risk.
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Sebastian et al. (2006) studied this question.
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