What are cardiac effects of regional anesthesia relevant to perioperative cardiac management?

Updated: Feb 04, 2019
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

Both epidural and spinal anesthetics cause arteriodilation and venodilation by blocking sympathetic outflow, decreasing preload, and, ultimately, reducing cardiac output. To offset this deleterious effect, the clinician may volume load the patient preoperatively. However, this intervention increases the risk of postoperative CHF by 10-15%.

Although many clinicians believe that regional anesthesia is safer than general anesthesia, randomized studies comparing the 2 modalities have shown no difference in cardiopulmonary complications or mortality. Combined epidural and general anesthesia with analgesia for pain control may attenuate sympathetic hyperactivity, reduce the need for additional parenteral analgesia postoperatively, improve postoperative pulmonary function, and reduce the duration of stay in the intensive care unit following surgery. [2]


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