Thoracic epidural anaesthesia and analgesia and outcome

Abstract

Thoracic - but not lumbar - epidural anaesthesia provides relevant clinical advantages compared with general anaesthesia, improving patients' morbidity and mortality after major surgical procedures. These advantages are excellent perioperative neuraxial analgesia and effective attenuation of the perioperative stress response by a reversible blockade of sympathetic afferents and efferents. In particular the attenuation of sympathetic tone prevents perioperative myocardial ischaemia and improves global and regional left ventricular function, pulmonary function and gastrointestinal perfusion. Thus, thoracic epidural anaesthesia is more than simply an anaesthetic regimen; it also has therapeutic options, especially in high-risk patients who underwent major cardiac, thoracic or abdominal surgical procedures.