Chapter 55: Regional Anesthesia for Cardiac and Thoracic Anesthesia

Chapter 55. Regional Anesthesia for Cardiac and Thoracic Anesthesia

The use of high thoracic epidural analgesia/anesthesia (hTEA) for cardiac surgery results in a segmental thoracic sympathectomy. This sympatholysis results in which of the following physiological effects?

A. Decreased stability of intraoperative hemodynamics

B. Dilation of the coronary and internal mammary arteries

C. Increased frequency of cardiac arrhythmias

D. Increased heart rate

B is correct. The sympatholysis that results from high thoracic epidural analgesia (hTEA) results in dilation of both the coronary and internal mammary arteries and therefore improves perfusion to the respective vessels.

A is incorrect. The sympathectomy that results from hTEA typically results in improved stability of intraoperative hemodynamics.

C is incorrect. Because of the improved hemodynamics and perfusion that result from the sympathectomy after hTEA, the frequency of cardiac dysrhythmias is decreased.

D is incorrect. Heart rate is typically decreased after hTEA as a result of the sympathectomy and the resultant blockade of cardiac accelerator fibers.

The most recently published estimation of the risk of epidural hematoma formation related to thoracic epidural analgesia (TEA) in cardiac surgery patients is:

A. 1:5000

B. 1:12,000

C. 1:40,000

D. 1:75,000

B is correct. The most recently published risk estimation of hematoma as a result of epidural blockade is 1:12,000 with a previously reported 95% confidence interval of 1:150,000 to 1:1500.

A, C, and D are incorrect. As stated above, the estimated risk of epidural hematoma following epidural hematoma placement in cardiac surgery is 1:12,000.

When performing an awake cardiac surgery using high thoracic epidural anesthesia (hTEA), which of the following is a major disadvantage of this technique?

A. Can only be utilized for off-pump coronary artery bypass surgery

B. Does not allow for the performance of transesophageal echocardiography (TEE)

C. Has a low patient acceptance rate

D. Is associated with increased costs

B is correct. Intraoperative transesophageal echocardiography (TEE) has become a standard procedure for patients undergoing cardiac surgery, but unfortunately employing a regional anesthesia technique that allows for awake cardiac surgery does not allow for the use of TEE as it cannot be performed on an awake patient.

A is incorrect. There have been both case reports and ...