Thoracic epidural anesthesia for cardiac surgery

cardiac surgery has its roots in the groundbreaking work by Blomberg et al.1–4 Following this examination of the effect of TEA on patients with coronary artery disease, others including this author were enthused to apply these findings to patients undergoing cardiac surgery. Throughout the 90’s, additional work was done to document the role of TEA in cardiac surgery. The major impediment to broader application was then, and is still now, concern regarding epidural hematoma formation. This refresher course is intended to review both the early and more current findings regarding the benefits of TEA for cardiac surgery as well as review many of the ancillary benefits that accrue from the use of TEA including earlier extubation, improved pain management and improvement in pulmonary function. There will also be a general discussion of the relative risk of epidural hematoma formation when TEA is used during cardiac surgery.