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Reducing Mortality in the Perioperative Period pp 29–34Cite as

Can Neuraxial Anesthesia Reduce Perioperative Mortality?

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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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Author information

Authors and Affiliations

  1. Dante Pazzanese Institute of Cardiology, Federal University of Sao Paulo – UNIFESP, São Paulo, Brazil

    Caetano Nigro Neto MD, PhD

  2. Santa Paula Hospital – Anesthesiology and Pain Management Department, Reference Scientific Anesthesiology Board of the Sao Paulo Medical Association (APM), São Paulo, Brazil

    Alexandre Slullitel MD

  3. Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    John G. Augoustides MD, FASE, FAHA

Authors
  1. Caetano Nigro Neto MD, PhD
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  2. Alexandre Slullitel MD
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  3. John G. Augoustides MD, FASE, FAHA
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Corresponding author

Correspondence to John G. Augoustides MD, FASE, FAHA .

Editor information

Editors and Affiliations

  1. Anestesia Rianimazione e Terapia Intensiva, Università Vita-Salute San Raffaele Ospedale San Raffaele, Milan, Italy

    Giovanni Landoni

  2. Anestesia Rianimazione e Terapia Intensiva, Università Vita-Salute San Raffaele Ospedale San Raffaele, Milan, Italy

    Laura Ruggeri

  3. Anestesia Rianimazione e Terapia Intensiva, Università Vita-Salute San Raffaele Ospedale San Raffaele, Milan, Italy

    Alberto Zangrillo

Summary Table

Summary Table

Clinical summary

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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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46695-8

  • Online ISBN: 978-3-319-46696-5

  • eBook Packages: MedicineMedicine (R0)

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