Anaesthesia for Endoluminal Repair of Abdominal Aortic Aneurysms

Abstract

An audit of 100 patients undergoing elective abdominal aortic surgery either by open aortic repair (OAR group 50 patients) or endovascular aortic repair (EAR group 50 patients) was undertaken to document changes in anaesthetic technique and perioperative outcome. The data for the OAR group was collected retrospectively and that for the EAR group prospectively. Combined general anaesthesia and thoracic epidural anaesthesia was used in 44 of the OAR group whereas lumbar central neural blockade alone was used in 47 of the EAR group. The major differences between the two groups were that intraoperative blood loss was significantly less in the EAR group (OAR 1674±1008 ml, EAR 459±350 ml, P<0.001) and that no patient in the EAR group required admission to the Intensive Care Unit (ICU), whereas ICU time for the OAR patients was 29±22 hours. Hospital stay was also significantly different between the two groups (OAR 13±6 days, EAR 5±3 days, P<0.001). Major complications occurred in 20 patients in the OAR group but only 4 patients in the EAR group (P<0.001). EAR reduces blood loss, the requirement for ICU admission, and hospital stay. Central neural blockade is a satisfactory anaesthetic technique for EAR.

Effects of study design and trends for EVAR versus OSR

“…Of these observational studies, 16 were categorized as multi-center (Zarins et al 1999; Beebe et al 2001; Criado et al 2003; Matsumura et al 2003; Akkersdijk et al 2004; Anderson et al 2004; Carpenter and Endologix 2004; Greenberg et al 2004; Forbes et al 2005; Hua et al 2005; Leon et al 2005; LREAR 2005; Bush et al 2006; Mendonca et al 2005; Sandridge et al 2006; Wald et al 2006). The other 59 papers were single center evaluations subdivided based on annual surgical volume of 30 cases per year, identified 31 low volume centers (de Virgilio et al 1999; Kahn et al 1999; Seiwert et al 1999; Treharne et al 1999; Becquemin et al 2000; Cohnert et al 2000; Malina et al 2000; Sangiorgi et al 2001; Berman et al 2002; Davies et al 2002; Forbes et al 2002; Ligush et al 2002; Van Sambeek et al 2002; Gawenda et al 2003; Hansman et al 2003; Patel et al 2003; Ting et al 2003; Turnipseed et al 2003; Ballard et al 2004; Garcia-Madrid et al 2004; Zeebregts et al 2004; Aarts et al 2005; Borchard et al 2005; Goueffic et al 2005; Hayter et al 2005; Iannelli et al 2005; Rosenberg et al 2005; de Donato et al 2006; Manis et al 2006; Vogel et al 2005; Parmer et al 2006), and 28 high volume centers (Baxendale et al 1996; Du Toit et al 1998; Ceelen et al 1999; Scharrer-Pamler et al 1999; Clair et al 2000; Galle et al 2000; Odegard et al 2000; Bertrand et al 2001; …”