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Tracheal wall collapse produced by esophageal detector devices in a porcine cardiac arrest model.

In Response We agree with Jaigirdar et al. that insertion of an epidural catheter and the timing of its removal in patients undergoing liver resection remain controversial and largely unstudied. The dilemma for anesthesiologists is of course the risk of epidural hematoma when the epidural catheter is positioned or removed versus the potential risk of hepatotoxicity and excessive sedation associated with systemic opioids. One study does find a significant correlation between postoperative coagulation derangement and blood loss, suggesting that the coagulapathy observed immediately after surgery may be mostly related to the dilutional effect of the intraoperative fluids. Matot’s study, as was mentioned, concluded that epidural anesthesia used in conjunction with minor hepatic surgery is quite safe because only brief changes in coagulation occurred. On the other hand, in patients undergoing major hepatic surgery and in whom an epidural catheter was placed, removal of the catheter should be delayed until laboratory values are normal. In our trial, the mean blood loss volume was about 300 mL, hepatic function and measures of coagulation were maintained before surgery, and epidural catheters were not inserted if prothrombin time was longer than 15 seconds or blood platelet count was 80 10/mm, an indication more stringent than that in other studies. Hence, we believe that the thoracic epidural catheters removed at the end of surgery was quite safe in our patients.