The vertebral column forms part of the axis of the human body, extending in the midline from the base of the skull to the pelvis. Its four primary functions are protection of the spinal cord, support of the head, provision of an attachment point for the upper extremities, and transmission of weight from the trunk to the lower extremities. Pertinent to regional anesthesia, the vertebral column serves as the landmark for a wide variety of regional anesthesia techniques. It is important, therefore, that the anesthesiologist be able to develop a three-dimensional mental image of the structures comprising the vertebral column.
The decision to utilize regional anesthesia is dependent on many factors. Patient characteristics, the type of surgery proposed, and the potential anesthetic risks will all have an impact on anesthetic choice and perioperative management. In patients with cardiovascular disease, regional anesthesia techniques (either alone or in conjunction with general anesthesia) can offer the potential perioperative benefits of stress response attenuation, cardiac sympathectomy, earlier extubation, shorter hospital stay, and intense postoperative analgesia. However, the decision to utilize regional anesthesia should be made with caution in some circumstances. The aim of this chapter is to provide an overview of the physiological effects of different regional anesthesia techniques on the cardiovascular system, to examine the role of regional anesthesia in cardiac surgery and noncardiac surgery and to provide an overview of the physiological requirements of patients with different types of cardiac and vascular disease.