To Compare General, Epidural and Local Anaesthesia for Endovascular Aneurysm Repair (EVAR)

Béttex, Dominique; Lachat, Mario; Pfammatter, Thomas; Schmidlin, Daniel; Turina, Marko; Schmid, Edith R.

doi:10.1053/ejvs.2000.1295

Cited by 114 publications

(86 citation statements)

References 21 publications

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“…Emergency operation for aortic rupture or acute dissection is associated with a higher risk of early death after operation compared with elective operation (47 Choice of anesthetic technique is dependent on the planned surgical interventions and the patient's comorbid conditions. For placement of endovascular aortic stent grafts, different anesthetic (local, regional, general) techniques have been described, although adequate comparative studies are lacking (637)(638)(639)(640)(641)(642)(643). Percutaneous placement of catheters with a limited incision may be tolerated with local anesthesia and sedation.…”

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

“…Retrospective studies indicate that patients having local versus regional or general anesthesia for endovascular stent grafts tend to have lower use of vasoactive agents and lower fluid requirements, shorter intensive care and hospital stays (642), earlier ambulation and gastrointestinal function (637), and lower incidence of respiratory and renal complications (643). In a large multicenter retrospective study of 5557 patients undergoing endovascular aortic repairs (644), 69% received general anesthesia, 25% received regional anesthesia, and 6% received local anesthesia.…”

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

Hiratzka¹,

Bakris²,

Beckman³

et al. 2010

Journal of the American College of Cardiology

1,286

379

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Section: Preoperative Risk Assessmentmentioning

confidence: 99%

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

Hiratzka¹,

Bakris²,

Beckman³

et al. 2010

Journal of the American College of Cardiology

1,286

379

View full text Add to dashboard Cite

“…However, the length of stay in hospital was significantly shorter in LAS group. The use of inotropes and crystalloids and duration of the procedure were also significantly less [26]. This contradictory results are interesting; but could be attributed to the experiences of the team, and characteristics of patient population.…”

Section: Discussionmentioning

confidence: 95%

Anesthetic Management and Perioperative Complications in Endovascular Interventions: The Turkish Experience

Erkılıç¹,

Kesimci²,

Döğer³

et al. 2015

Glob J Anesth

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Background and Aim: Thoracic, abdominal and thoraco-abdominal aortic pathologies have highest mortality and morbidity causing pathologies in cardiovascular surgery. Co-existing diseases and age significantly increase risk of anesthesia and mortality rate in treatment of these patients. Endovascular techniques are used increasingly due to minimally invasive approach, decreased anesthesia risk during implementation, reduced length of hospital stay, and low mortality and mobidity rates. The aim of this investigation was to report our anesthetic experiences in endovascular techniques performed at our center. Materials and Methods:We evaluated 120 (19 females, 101 males; mean age: 67±12 years) consecutive symptomatic patients with thoracic and abdominal aortic pathologies who underwent endovascular stent graft surgery with either general or regional anesthesia or sedoanalgesia between 2009 and 2014, at our center. Results:The number of patients having abdominal endovascular stent graft surgery was 81. Among the rest; 87% underwent thoracic endovascular aneurysm repair, while 13% had both of the interventions. The duration of anesthesia and surgery was not different among the intervention groups. 86.8% of patients had general anesthesia, while 12.3% and 0.9% had regional anesthesia and sedoanalgesia; respectively. Postoperatively, the rate of being intubated and the length of stay in intensive care unit were found significantly lower in endovascular aortic repair (EVAR) group.Conclusion: EVAR should be considered as a beneficial alternative treatment option for high-risk and inoperable, elderly patients. Anesthesiological approach to be selected in these patients may be affected not only by general condition and cooperation of the patient, but also by the location of the pathology and duration of the process. Thus, the anesthesiologists should be prepared to face issues related to the patient's safety both during the administration of anesthesia and in the postoperative period.for a consecutive series of patients who underwent endovascular abdominal and thoracalaneurysm repair in our institution within a 5-year period.

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“…Elective EVAR using local anaesthesia has demonstrated benefits including reduced ICU and hospital stay [72][73][74][75] and decreased pulmonary morbidity [75]. A meta-analysis of 39 articles and 2387 patients undergoing elective EVAR found that general anaesthesia was an independent risk factor for death, with an odds ratio of 5.1 (95% CI 1.9-13.3) [76].…”

Section: Is Local Anaesthesia a Better Choice?mentioning

confidence: 99%

Anaesthesia for vascular emergencies

Ellard¹,

Djaiani

2012

Anaesthesia

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SummaryPatients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management. In-hospital mortality after open repair of ruptured abdominal aortic aneurysm (rAAA) approaches 40-50% with total mortality, including pre-hospital deaths, closer to 80% [1][2][3]. Traumatic thoracic aortic injury is often immediately fatal with a 30-40% mortality in those who arrive alive to hospital and an overall mortality of 90% [4]. Thirty-day mortality rates are > 50% following ruptured thoracic aneurysm [5], 13% for acute type B dissection [6] and > 25% following embolectomy for acute limb ischaemia [7,8].We define a 'vascular emergency', for the purpose of this review, as an acute condition requiring intervention within hours, involving the descending aorta and its main lower limb branches. Specific pathologies meeting these criteria include acute aortic syndrome, ruptured thoracic and abdominal aneurysms, traumatic injuries of the thoracic aorta and acute lower limb ischaemia. Pathology involving the ascending aorta or aortic arch that is generally managed by cardiac surgeons is excluded.This review aims to discuss the optimal anaesthetic management to minimise morbidity and mortality and the impact of a move towards endovascular repair. An English language electronic search using Medline and Embase databases identified relevant scientific literature from the last 10 years and was supplemented with a manual search of reference lists from reviewed articles. Overview of vascular emergenciesAcute aortic syndrome Acute aortic syndrome consists of three interrelated conditions: penetrating atherosclerotic ulcer; intramural haematoma; and aortic dissection. Penetrating athero-

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To Compare General, Epidural and Local Anaesthesia for Endovascular Aneurysm Repair (EVAR)

Abstract: LA is a safe anaesthetic method for the endovascular repair of infrarenal abdominal aneurysm, offering several advantages: simplicity, stable haemodynamics, and reduced consumption of ICU and hospital beds.

Cited by 114 publications

References 21 publications

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

Anesthetic Management and Perioperative Complications in Endovascular Interventions: The Turkish Experience

Anaesthesia for vascular emergencies

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