الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Thoracic epidural anesthesia and analgesia provides excellent postoperative analgesia after major thoraco-abdominal and cardiac surgery and, therefore, may paly role in the postoperative morbidity after these high-risk surgical procedures. The improved analgesia is particularly evident when local anesthetics and opioids are combined and analgesia is assessed during activity. The perioperative use of TEA may beneficially affect outcome by producing intense postoperative analgesia, stress-response attenuation, and thoracic cardiac sympathectomy reducing the incidence and severity of the perioperative physiologic perturbations. The combination of TEA and general anesthesia has been shown to produce beneficial effects such as reduced hemodynalnic correlates of myocardial oxygen consumption, improved intraoperative hemodynamic stability, and reduced stress response.
Outcome benefit from TEA can be reasonably expected only when its intraoperative use is extended to the postoperative period. TEA improves cardiac performance and may even have beneficial effects on the oxygen delivery/demand ratio. TEA has beneficial effects on several variables (Catecholamines, nitrogen balance, coagulation) that correlate with improved outcome. Lung fimction may also benefit from TEA allows early extubation postoperatively, improves patient awareness, and provides excellent analgesia particularly during activity so the patient can take deep expansive breaths, cough freely .