Abstract
Neuraxial anesthesia results from injection of local anesthetics into the subarachnoid space (spinal anesthesia) and/or into the epidural space (epidural anesthesia). According to two recent systematic reviews, neuraxial anesthesia compared with general anesthesia may reduce postoperative mortality in surgical procedures, especially in patients with intermediate-to-high cardiac risk [1, 2]. In the first analysis, Guay et al. summarized nine Cochrane systematic reviews in order to assess whether anesthetic technique influences mortality after surgery [1]. Compared with general anesthesia, neuraxial anesthesia alone reduced perioperative mortality up to 30 days after surgery (risk ratio 0.71; 95 % confidence interval 0.53–0.94: analysis of 20 studies with a cumulative N = 3006) [1]. Compared with general anesthesia alone, combined neuraxial and general anesthesia had no significant effect on perioperative mortality up to 30 days after surgery (relative risk 1.07; 95 % confidence interval 0.76–1.51: analysis of 18 studies with a cumulative N = 3228) [1]. In the second analysis, Pöpping et al. evaluated the impact on mortality of concomitant epidural analgesia, compared with systemic analgesia, in adults having surgery under general anesthesia (cumulative N = 2201: ten randomized controlled trials published up until July 2012) [2]. The results showed that there was a significant reduction in mortality risk associated with epidural analgesia (3.1 % vs 4.9 %; odds ratio 0.60; 95 % confidence interval 0.39–0.93) [2]. The results obtained in these two recent systematic reviews were in agreement with the findings from earlier analyses published in 2000 [3, 4]. Despite these recent publications, there is ongoing debate about whether neuraxial blockade can reduce perioperative mortality. Recent large high-quality trials have focused on this important question. This chapter will review the main recent trials in this area and develop an evidence-based answer to this debate.
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References
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Summary Table
Summary Table
Clinical summary | |||
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Technique | Indications | Cautions | Notes |
Neuraxial anesthesia | Lower-extremity major joint procedures | Neuraxial hematoma | Suggestive reduction in mortality |
Neuraxial anesthesia/analgesia | Cardiac surgery | Neuraxial hematoma | No conclusive effect on mortality |
Neuraxial anesthesia | Lower-extremity vascular surgery | Neuraxial hematoma | No conclusive effect on mortality |
Neuraxial anesthesia | Elective endovascular aortic aneurysm repair | Neuraxial hematoma | No conclusive effect on mortality |
Neuraxial anesthesia | Cancer surgery | Neuraxial hematoma | Suggestive reduction in mortality |
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Neto, C.N., Slullitel, A., Augoustides, J.G. (2017). Can Neuraxial Anesthesia Reduce Perioperative Mortality?. In: Landoni, G., Ruggeri, L., Zangrillo, A. (eds) Reducing Mortality in the Perioperative Period. Springer, Cham. https://doi.org/10.1007/978-3-319-46696-5_5
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DOI: https://doi.org/10.1007/978-3-319-46696-5_5
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