Neuraxial anesthesia and timing of heparin administration in patients undergoing surgery for congenital heart disease using cardiopulmonary bypass

Objective: The goal of this review was to add to the existing literature documenting the safety of performing neuraxial techniques in patients who are subsequently fully heparinized, with particular emphasis on the timing of heparin administration. This will help improve risk estimation and possibly lead to a more widespread use of neuraxial anesthesia in patients undergoing cardiac surgery. Design: Retrospective chart review. Setting: Single tertiary-care university hospital. Participants: All patients undergoing surgery for congenital heart diseases during a 5-year period. Interventions: The medical records of all patients undergoing surgery for congenital heart diseases during a 5-year period were reviewed for any complications related to the use of neuraxial anesthesia. Furthermore, the interval from neuraxial anesthesia to heparinization for cardiopulmonary bypass was examined. Results: In total, 714 patients were identified who had neuraxial anesthesia administered before full heparinization for cardiopulmonary bypass. No cases of symptomatic spinal or epidural hematomas occurred. Further analysis showed that the interval from neuraxial anesthesia to full heparinization was <1 hour in 466 patients. Conclusions: No complications related to neuraxial anesthesia were found in a series of 714 patients undergoing surgery for congenital heart disease using cardiopulmonary bypass, including 466 patients in whom the interval from neuraxial anesthesia to full heparinization was <1 hour.