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Review
. 2015 Mar 15;20(1):25.
doi: 10.1186/s40001-015-0091-y.

Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials

Shengsuo Zhang  1 , Xinmin Wu  2 , Hang Guo  3 , Li Ma  4
Affiliations
Review

Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials

Shengsuo Zhang et al. Eur J Med Res. .

Abstract

To assess the efficacy of thoracic epidural anesthesia (TEA) with or without general anesthesia (GA) versus GA in patients who underwent cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of Science were searched with the limit of randomized controlled trials (RCTs) relevant to 'thoracic epidural anesthesia' and 'cardiac surgery'. Studies were identified and data were extracted by two reviewers independently. The quality of included studies was also assessed according to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory functions, and treatment-associated complications were pooled and analyzed. The comprehensive search yielded 2,230 citations, and 25 of them enrolling 3,062 participants were included according to the inclusion criteria. Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05). With regard to treatment-related complications, the pooled results for respiratory complications (risk ratio (RR), 0.69; 95% CI: 0.51, 0.91, P < 0.05), supraventricular arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P < 0.05), and pain (mean difference (MD), -1.27; 95% CI: -2.20, -0.35, P < 0.05) were 0.69, 0.61, and -1.27, respectively. TEA was also associated with significant reduction of stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P < 0.05) and hospital (MD, -1.51; 95% CI: -3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, -2.06; 95% CI:-2.68, -1.45, P < 0.05). TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.

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Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias of included studies based on the authors’ judgement.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
Funnel plot of included studies relevant to mortality.
Figure 5
Figure 5
A Forest plot for the comparison of epidural anesthesia versus control on the pooled endpoint death.
Figure 6
Figure 6
Meta-analysis of the effect of epidural anesthesia versus control on the composite endpoint myocardial infarction.
Figure 7
Figure 7
Summarized comparison of epidural anesthesia versus control on the pain relief.
Figure 8
Figure 8
A Forest plot for the comparison of epidural anesthesia versus control on the outcome of stays in intensive care unit.
Figure 9
Figure 9
A Forest plot for the comparison of epidural anesthesia versus control on the stays in hospital.
Figure 10
Figure 10
A Forest plot for the comparison of epidural anesthesia versus control on the composite endpoint time to tracheal extubation.
Figure 11
Figure 11
A meta-analysis of the comparison of epidural anesthesia versus control on the supraventricular tachyarrhythmias.
Figure 12
Figure 12
A Forest plot for the comparison of epidural anesthesia versus control on the composite endpoint respiratory complications.
Figure 13
Figure 13
A Forest plot for the comparison of epidural anesthesia versus control on the composite endpoint stroke.
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