Combined Epidural and General Anesthesia versus General Anesthesia for Abdominal Aortic Surgery

Baron, J. F.; Bertrand, Michèle; Barré, Éric; Godet, G.; Mundler, O.; Coriat, Pierre; Viars, P.

doi:10.1097/00000542-199110000-00010

Cited by 204 publications

(36 citation statements)

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“…This is in accordance with other publications. [29][30][31] We did not see a beneficial effect of epidural anesthesia on pHi-and CO 2 difference of gastric mucosa. Likewise Väisänen et al, 3 2 who evaluated the effect of epidural anesthesia on splanchnic blood flow and gastric and sigmoid mucosal pH in 20 patients undergoing abdominal aortic surgery, found that epidural anesthesia did not improve splanchnic blood flow or tissue oxygenation.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

Piper

Boldt

Schmidt

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To evaluate the effects of perioperative epidural analgesia on hemodynamics, splanchnic perfusion and regulators of circulation.Methods: Twenty patients undergoing aortic surgery were randomised into two groups: epidural analgesia group (EAG): epidural analgesia with bupivacaine (15 ml, 0.125%) was started before surgery. Eight and 16 hr postoperatively 10 ml bupivacaine 0.125% and 1 mg morphine were given. Control group (COG): patients received no epidural catheter. Monitoring included pulmonary artery catheter and gastric tonometer. Norepinephrine, epinephrine, renin, ADH, ANP and endothelin were measured: before epidural analgesia (T0), before aortic clamping (T1), 20 min after aortic clamping (T2), after declamping the first leg (T3), at end of surgery (T4), one hour (T5) and 24 hr postoperatively (T6).Results: At T5 mean arterial blood pressure decreased in EAG compared with baseline (86 ± 16 to 75 ± 8 mmHg) and compared with COG (75 ± 8 vs 84 ± 11 mmHg). At T2 pulmonary capillary wedge pressure and cardiac index increased and at T6 decreased in both groups. Systemic vascular resistance decreased at T1 and at T3-T5 in EAG compared with COG and at T1 and T3-T6 to baseline (1472 ± 448 to 1027 ± 184 dyn· sec·cm). In EAG and in COG, pHi decreased compared with baseline but without group differences. In both groups, epinephrine, norepinephrine, renin, and ADH levels increased from baseline. Endothelin and ANP levels showed no changes.Conclusions: Perioperatively administrated epidural bupivacaine has no beneficially effects on hemodynamics, pHi or release of regulators of circulation.Objectif : Étudier les effets de l'analgésie péridurale périopératoire sur l'hémodynamie, la perfusion splanchnique et les régulateurs de la circulation.Méthode : Vingt patients subissant un pontage aortique infrarénal ont été répartis au hasard en deux groupes : un groupe GP recevant l'analgésie péridurale avec bupivacaïne (15 ml à 0,125 %) avant l'opération, suivis de 10 ml de bupivacaïne à 0,125 % et de 1 mg de morphine 8 h et 16 h après l'opération; un groupe témoin GT sans cathéter épidural. Le monitorage comprenait un cathéter de l'artère pulmonaire et un tonomètre gastrique. Les régulateurs de circulation étaient mesurés sur des échantillons de sang : avant l'analgésie péridurale (T 0 ), avant le clampage aortique (T 1 ), 20 min après le clampage aortique (T 2 ), après déclampage de l'artère iliaque d'un côté (T 3 ), à la fin de l'opération (T 4 ), 1 h après l'opération (T 5 ) et 24 h après l'opération (T 6 ).Résultats : À T5, la pression artérielle moyenne diminuait dans le GP par rapport aux mesures initiales (86 ± 16 à 75 ± 8 mmHg) et comparé au GT (75 ± 8 vs 84 ± 11 mmHg). À T 2 , la pression capillaire pulmonaire et l'index cardiaque étaient élevés et à T 6 diminués de façon similaire dans les deux groupes. Les résistances vasculaires systémiques diminuaient à T 1 et T 3 -T 5 dans le GP en comparaison avec le GT et à T 1 et T 3 -T 6 par rapport aux mesures initiales (1472 ± 448 à 1027 ± 184 dyn"sec/cm 5"m2. Dans...

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Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

Piper

Boldt

Schmidt

et al. 2000

Can J Anesth/J Can Anesth

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“…Again, this is consistent with earlier findings. 35,36 The effect of postoperative analgesic regimen on cardiac outcome was not investigated in this study.…”

Section: Discussionmentioning

confidence: 99%

ACC/AHA guidelines as predictors of postoperative cardiac outcomes

Ali

Davison

Pickett

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: Recently, the American College of Cardiology -American Heart Association (ACC-AHA) published guidelines and an associated algorithm for preoperative cardiovascular evaluation of patients undergoing non-cardiac surgery. Our purpose was to (i) test guideline's ability to predict adverse cardiac events within seven days after surgery, (ii) determine whether medical clinical predictors or surgical risks was a better predictor of cardiac events.Methods: Retrospective review of 119 cardiology and anesthesia consultations over 15 mo, ending March 31, 1998. Patients were classified into their respective medical clinical predictor and surgical risk groups, as outlined in ACC-AHA guidelines. Associations between the medical predictor and surgical risk scores and adverse cardiac outcomes were quantified via multiple logistic regression analysis. Two outcomes were employed. Outcome 1, included: myocardial infarction/ischemia; angina; congestive heart failure, arrhythmia or death. Outcome 2 expanded the definition to include "cancellation of surgery due to cardiac risk" as a negative cardiac outcome.Results: Diabetes, Canadian Cardiovascular Class (CCS) 111 or 1V angina, and MI within six months before surgery were strongly associated with the two cardiac outcomes. For outcome 1 and 2, medical predictors and surgical risks, considered simultaneously, performed with a sensitivity of 93% and specificity of 46-51%. When considered separately, major clinical medical predictors had a sensitivity of 87-89%, while surgical risks showed a specificity of 89% in predicting the two outcomes.Conclusion: Medical predictors in ACC-AHA classification scheme were highly sensitive whereas surgical risks were more specific in predicting adverse post-operative cardiac events. Prospective study is needed to confirm these observations. Objectif Objectif :: Récemment, l'American College of Cardiology -American Heart Association (ACC-AHA) a publié des recommandations, et un algorithme qui leur est associé, pour l'évaluation cardiovasculaire préopératoire des patients qui doivent subir une intervention chirurgicale non cardiaque. Notre objectif était de (i) tester la capacité des recommandations à prédire les complications cardiaques qui pourraient se produire dans les sept jours suivant l'opération, (ii) déterminer si ce sont les facteurs prédictifs médicaux cliniques ou les risques chirurgicaux qui peuvent le mieux prédire les complications cardiaques. Méthode Méthode :: On a procédé à une revue rétrospective de 119 consultations en cardiologie et en anesthésie des 15 mois précé-dant le 31 mars 1998. Les patients ont été répartis en divers groupes selon leur facteur prédictif médical clinique respectif et les risques chirurgicaux liés à leur condition, comme l'indiquent les recommandation ACC-AHA. Les associations entre les facteurs prédictifs médicaux et les scores de risques chirurgicaux et les complications cardiaques ont été quantifiées au moyen d'une analyse de régression logistique multifactorielle. Deux complications ont servi à l...

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“…Seven randomized clinical trials conducted in patients undergoing vascular surgery demonstrated no differences in outcome when regional and general anesthesia techniques were compared. [482][483][484][485][486][487][488] One trial of 168 patients undergoing abdominal aortic surgery specifically examined the relative importance of intraoperative versus postoperative epidural anesthesia and analgesia compared with general anesthesia on outcomes. 487 No differences in major morbidity, length of stay, or mortality rate were observed.…”

Section: Anesthetic Considerations and Intraoperative Managementmentioning

confidence: 99%

“…Several studies have evaluated differing combinations of general and epidural anesthesia and intravenous and epidural analgesia. [482][483][484][485][486] Patients having epidural anesthesia/analgesia have demonstrated lower opiate dosages, better ablation of the catecholamine response, and a less hypercoagulable state. 491,492 In 1 study of patients undergoing lower-extremity vascular bypass procedures, 483 the use of epidural anesthesia/analgesia was associated with a lower incidence of cardiac morbidity; however, this finding was not confirmed in 2 other studies.…”

Section: Perioperative Pain Managementmentioning

confidence: 99%

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher

Beckman²,

Brown³

et al. 2009

Circulation

269

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Combined Epidural and General Anesthesia versus General Anesthesia for Abdominal Aortic Surgery

Cited by 204 publications

References 0 publications

RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

RETRACTED ARTICLE: Hemodynamics, intra-mucosal pH and regulators of circulation during perioperative epidural analgesia

ACC/AHA guidelines as predictors of postoperative cardiac outcomes

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

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