Epidural Anaesthesia and Mini-Laparotomy for the Treatment of Abdominal Aortic Aneurysms in Patients with Severe Chronic Obstructive Pulmonary Disease

Kalko, Yusuf; Uğurlucan, Murat; Başaran, Murat; Ünal, Aydın; Kafa, Ülkü; Kösker, Taylan; Süren, Mustafa; Yaşar, Tahsin

doi:10.1080/00015458.2007.11680062

Cited by 18 publications

(9 citation statements)

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“…Successful elective OSR using "mini-laparotomy" or by retroperitoneal exposure has been performed using epidural anesthesia with either low dose inhalation anesthesia or in the awake patient. [371][372][373] These techniques should be considered experimental.…”

Section: Choice Of Anesthetic Technique and Agentmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

625

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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Section: Choice Of Anesthetic Technique and Agentmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

625

520

View full text Add to dashboard Cite

show abstract

“…Finally, in patients with severe chronic obstructive pulmonary disease, epidural anesthesia should be considered. 10,14 The hybrid procedure for juxtarenal aneurysms appears advantageous, mainly considering complex surgical procedures required during open repair. 10,14 The invasiveness of open repair cannot be compared with that of the abdominal aortic banding, which ensures a quick recovery and allows, through juxtarenal aortic reshaping, an otherwise not eligible standard EVAR.…”

Section: Discussionmentioning

confidence: 99%

Aortic banding and endovascular aneurysm repair in a case of juxtarenal aortic aneurysm with unsuitable infrarenal neck

Scarcello

Serra

Morrone

et al. 2012

Journal of Vascular Surgery

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The proximal aortic neck is one of the limiting factors for endovascular aneurysm repair (EVAR) and represents a crucial factor for success or failure of the procedure. In contrast to open surgery, where a clamp can be placed suprarenally but the repair performed infrarenally, EVAR requires a good infrarenal neck for durable fixation and seal. In a high-risk surgical 79-year-old patient with juxtarenal aortic aneurysm with unsuitable infrarenal neck, a hybrid procedure was chosen: juxtarenal aortic banding and EVAR. The banding allowed a successful EVAR by reshaping the juxtarenal aneurysmal aortic segment, hence converting a previously untreatable anatomy into a treatable one.

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“…Groeben et al [21] performed high thoracic segment epidural anesthesia in COPD and asthma patients undergoing breast surgery and reported only small decreases in FEV 1.0 . Kalko et al [94] also reported that epidural anesthesia for abdominal aortic aneurysm repair through minilaparotomy was feasible and should be seriously considered in patients with severe COPD when endovascular treatment cannot be performed. In patients with severe COPD with FEV 1.0 of 50% or less, Savas et al [95] reported that abdominal surgery could be safely performed using regional anesthesia alone.…”

Section: Suppression Of Neural Refl Exesmentioning

confidence: 96%

Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease

2008

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Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

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Epidural Anaesthesia and Mini-Laparotomy for the Treatment of Abdominal Aortic Aneurysms in Patients with Severe Chronic Obstructive Pulmonary Disease

Abstract: Epidural anaesthesia for abdominal aortic aneurysm repair through mini-laparotomy is feasible and should be especially considered in patients with severe COPD where endovascular treatment could not be performed.

Cited by 18 publications

References 0 publications

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Aortic banding and endovascular aneurysm repair in a case of juxtarenal aortic aneurysm with unsuitable infrarenal neck

Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease

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