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Technical aspects of high thoracic epidural analgesia in cardiac surgery

机译：心脏外科手术中高胸腔硬膜外镇痛的技术方面

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摘要

This review focuses on technical aspects of high thoracic epidural analgesia (TEA) when used in conjunction with general anesthesia for patients undergoing cardiac surgery. Several issues are discussed: the type of surgery, the importance of anticoagulation, and the timing of the TEA insertion. In addition, practical concerns, such as the type and dose of local anesthetics and possible adjuncts, the duration of TEA treatment, the interaction between TEA and postoperative anticoagulation, or the consequence of inadvertent bloody tap, are presented. This author proposes the insertion of the thoracic epidural catheter at least 1 hour before heparinization, in the high thoracic region via median approach. Correct positioning of the catheter, which should be fixed with a secure dressing device, can be achieved via the injection of 2 mL lidocaine 1% with epinephrine 1:200,000. Should a bloody tap occur, a distinction between venous and arterial origin should be made and surgery postponed for at least 24 hours, only in the case of arterial tap. Trouble-shooting for commonly encountered problems with TEA in cardiac surgery is outlined as well as management of suspected epidural hematoma.
机译：这篇综述着重介绍了胸腔硬膜外镇痛（TEA）与心脏外科手术患者全身麻醉一起使用时的技术方面。讨论了以下几个问题：手术类型，抗凝的重要性以及TEA的插入时间。此外，还提出了一些实际问题，例如局部麻醉药的类型和剂量以及可能的辅助药物，TEA治疗的持续时间，TEA与术后抗凝药之间的相互作用，或无意带血的自来水的后果。作者建议通过中位入路在肝素化前至少1小时在高胸腔区域插入胸膜硬膜外导管。可以通过注入2 mL 1％的利多卡因和1：200,000肾上腺素实现导管的正确定位，该导管应使用安全的敷料装置固定。如果发生流血水龙头，则应区分静脉血源和动脉血源，并且仅在发生动脉血栓的情况下才应将手术推迟至少24小时。概述了心脏手术中TEA常见问题的疑难解答，以及疑似硬膜外血肿的处理。

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