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Chapter 55. Regional Anesthesia for Cardiac and Thoracic Anesthesia
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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?
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A. Decreased stability of intraoperative hemodynamics
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B. Dilation of the coronary and internal mammary arteries
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C. Increased frequency of cardiac arrhythmias
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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.
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A is incorrect. The sympathectomy that results from hTEA typically results in improved stability of intraoperative hemodynamics.
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C is incorrect. Because of the improved hemodynamics and perfusion that result from the sympathectomy after hTEA, the frequency of cardiac dysrhythmias is decreased.
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D is incorrect. Heart rate is typically decreased after hTEA as a result of the sympathectomy and the resultant blockade of cardiac accelerator fibers.
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The most recently published estimation of the risk of epidural hematoma formation related to thoracic epidural analgesia (TEA) in cardiac surgery patients is:
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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.
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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.
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When performing an awake cardiac surgery using high thoracic epidural anesthesia (hTEA), which of the following is a major disadvantage of this technique?
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A. Can only be utilized for off-pump coronary artery bypass surgery
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B. Does not allow for the performance of transesophageal echocardiography (TEE)
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C. Has a low patient acceptance rate
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D. Is associated with increased costs
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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.
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A is incorrect. There have been both case reports and ...