Minor side effects are common following the EBP. This terminology has been officially adopted in the International Classification of Headache Disorders and is used in this section. Some studies have reported a lower stress response during coronary artery bypass grafting (CABG) surgery in patients who received intrathecal bupivacaine in addition to general anesthesia compared to those who received general anesthesia and intravenous opioid (Intrathecal opioid in addition to GA has been studied for elective abdominal aortic surgery. In a small study of 10 patients scheduled for thoracotomy, a TEA with a mean analgesic level of C7 to T5 had only minor effects on the cardiovascular system.

In the context of this surgery, however, there are other causes of hemodynamic instability in addition to the effects of pain, specifically baroreceptor stimulation and sensitivity and impaired arterial pressure regulation following cerebrovascular accident (CVA).Although greater hemodynamic stability and reduced cardiovascular complications have been reported with the use of cervical plexus blockade compared to GA alone, and a meta-analysis including prospective and retrospective studies reported reduced incidences of stroke, myocardial infarction (MI), and death with the use of cervical plexus block without GA, these findings were potentially confounded by bias relating to the use of GA in higher-risk patients.

Patient characteristics, the type of surgery proposed, and the potential anesthetic risks will all have an impact on anesthetic choice and perioperative management. In general, tachycardia is poorly tolerated by hypertrophied hearts due to increased myocardial work, oxygen requirement, and a reduced diastolic time, which reduces both cardiac output via LV filling and coronary perfusion, further increasing the risk of myocardial ischemia. In their landmark observational study, Vandam and Dripps reported onset of headache symptoms within 3 days of spinal anesthesia in 84.8% of patients for whom such data were available.

With epidural procedures, patients with a history of ADP have been shown to be at slightly increased risk for another ADP (and subsequent PDPH).Needle size and tip design are the most important procedural factors related to PDPH.

Adenosine-mediated vasodilation may occur secondary to diminished intracranial CSF (in accordance with the Monro-Kellie hypothesis, which states that intracranial volume must remain constant) and reflexively secondary to traction on intracranial vessels. In an analysis of outcomes following ADP with 18-gauge Tuohy needles in an obstetric unit, Sadashivaiah reported 3 of 48 patients (6.25%) requiring a third EBP to relieve the headache. Whether this outcome results in a difference in morbidity or mortality is unclear, though, with some groups reporting no difference in outcome, and one reporting detrimental effects in the epi-dural group with rebound myocardial ischemia seen on termination of the epidural.TEA has been reported to be beneficial in morbidly obese patients undergoing gastric bypass surgery with better postoperative pain relief but no firm conclusions regarding cardiovascular function other than a significant reduction in SVR and intrapulmonary shunt compared to GA.The clinical effect of cardiac sympathectomy and peripheral vasodilation caused by TEA appears to vary between populations of patients. Patients should be warned to expect aching in the back, buttocks, or legs (seen in approximately 25% of patients). Hansdottir et al. Insertion in the operating room without reported epidural hematomas has also been described. Community See All. The investigators also found that TEA may increase the diameter of stenotic epicardial coronary arteries in patients with coronary artery disease without causing a dilation of coronary arterioles.Intraoperatively, during abdominal aortic aneurysm surgery, Reinhart et al observed a lower cardiac index and O2 delivery (QO2) in patients receiving TEA and general anesthesia (GA) than in those receiving GA alone; VO2 was similar. As in all other circumstances in which regional anesthesia is proposed, attention should be paid to anticoagulation, weighing the potential thromboembolic risks of stopping anticoagulation against the potential benefits.
Because PDPH can be anticipated to resolve spontaneously, headaches that worsen over time and no longer have a positional nature should be strongly suspected to be secondary to SDH (especially if there are focal neurologic signs or decreases in mental status). In addition to anesthesia interventions, PDPH remains a too-common iatrogenic complication following myelography and diagnostic/therapeutic lumbar puncture (LP). amputation, extrem-ity debridement, etc), can be life-saving in patients with severe cardiovascular disease, such. Regardless, despite the paucity of evidence, pharmacologic measures—particularly caffeine—continue to be widely used in hopes of decreasing the incidence or severity of PDPH following meningeal puncture. Practitioners (and patients alike) may also wish to carefully consider central neuraxial techniques in those with a previous history of ADP or PDPH (particularly females). The EBP should be encouraged in patients experiencing ADP with an epidural needle and those whose symptoms are categorized as severe (ie, pain score > 6 on a 1–10 scale).