To the Editor:--Fitzgibbons et al. correctly pointed out that there is high incidence of paraplegia after thoracic aneurysmectomy. [1]They also noted that tenuous collateral anastomosis of the anterior spinal artery is compromised during and after thoracic aneurysmectomy. Therefore, it is logical to conclude that any technique that increases the epidural and intrathecal pressure is likely to decrease the spinal cord blood supply. In addition, use of epinephrine (intrathecal or intraepidural) is likely to aggravate the situation by causing vasoconstriction. Therefore, I believe the choice of epidural route for pain relief in such a patient is most likely contraindicated.

Development of pain service units in the hospitals is a valuable service for the care of patients. Overzealous and aggressive use of these techniques is producing unwelcome results in various parts of the country. I believe it is imperative that all anesthesiologists report serious complications, so that we can have a better understanding of the causes of such disastrous events. A voluntary and confidential data bank should be established so that these cases could be reported and analyzed by a group of anesthesiologists who are actively involved in promoting the regional anesthesia techniques.

Biman B. Das, M.B.B.S. (Calcutta), F.R.C.A. (London), President Del Oro Anesthesiologists, P.A., P.O. Box 20553, Houston, Texas 77225–0553.

REFERENCE

1.
Fitzgibbon DR, Glosten B, Wright I, Tu R, Ready B: Paraplegia, epidural analgesia, and thoracic aneurysmectomy. ANESTHESIOLOGY 1995; 83:1355-9.