الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Background: At the beginning of the modern cardiac surgery era, routine overnight ventilation was one of the essential components of postoperative care. But recently low dose, short acting anesthetic agents replacing the former high dose opioid regimens offers a faster postoperative recovery and decreases the need for mechanical ventilatory support. Early extubation is a desired method in order to reduce the postoperative need for mechanical ventilation resulting in shorter periods of ICU stay, decreasing the cost of health care without compromising the patient’s safety.
Aim of the Work: To assesse the benefits and hazards of regional anesthesia during open heart surgeries.
Conclusion: Thoracic epidural anesthesia (TEA) has been established as a cornerstone in the perioperative care after thoracic surgery providing most effective analgesia. Beyond its analgesic properties, thoracic epidural anesthesia effects on the postoperative stress response, cardiovascular pathophysiology and intestinal dysfunction have been in the focus of both clinical and experimental investigations for years. However, as an invasive technique TEA is related to specific complications even when contraindications are properly considered. There is an ongoing debate whether these risks of TEA and its consumption of procedural resources in the perioperative period are worth the benefits with respect to outcome and organ protection.
Recommendations: Thoracic epidural anesthesia (TEA) has been shown to blunt the stress hormone response to coronary artery bypass graft surgery (CABG) and to decrease troponin release after cardiac surgery. TEA also reduces myocardial oxygen consumption and intra- and post-operative arrhythmias and improves analgsia and pulmonary function. Documented benefits of high thoracic epidural anesthesia include: decreased incidence of cardiovascular events (stroke, myocardial ischemia), less respiratory complications, less renal failure, and a lower infection rate; as well as a shorter ICU stay, lower cost of anesthesia, and earlier hospital discharge.