Thoracic epidural anaesthesia for treatment of refractory angina pectoris

Unstable angina is a dangerous condition with a high risk of developing myocardial infarction. The atherosclerotic plaque is exceedingly inflammatory and the unstable condition is due to a plaque rupture changing the anatomic configuration and associated with activation of the sympathetic nervous system and stenotic vasoconstriction and thrombosis. In spite of nitrates, β-blockers, calcium blockers and anti-platelet and anti-thrombotic drugs, there is refractory angina in about 10% of cases. These patients may successfully be treated with high thoracic epidural anaesthesia (HTEA), which is anti-anginal and anti-ischemic; if they are inoperable they can be discharged for long-term home self-treatment with tunnelled or inplantable HTEA devices. These have a low cost and are simple to insert and easy to handle, with a low risk for complications. There is also a decreasing need for injections with time, which may be explained by less tissue damage or intimal hyperplasia due to the sympathetic blockade.