Double-masked Randomized Trial Comparing Alternate Combinations of Intraoperative Anesthesia and Postoperative Analgesia in Abdominal Aortic Surgery

Norris, Edward J.; Beattie, Charles; Perler, Bruce A.; Martinez, Elizabeth A.; Meinert, Curtis L.; Anderson, Gerald F.; Grass, Jeffrey A.; Sakima, Neil T.; Gorman, Randolph B.; Achuff, Stephen C.; Martin, Barbara K.; Minken, Stanley L.; Williams, G. Melville; Traystman, Richard J.

doi:10.1097/00000542-200111000-00006

Cited by 193 publications

(72 citation statements)

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“…70 In a blinded trial, Jayr et al 71 demonstrated that epidural techniques provide superior postoperative analgesia, but do not affect the frequency of postoperative pulmonary complications. In another blinded trial, Norris et al 72 was unable to demonstrate a major outcome benefit of an epidural anesthetic technique, other than slightly shorter times to tracheal extubation. The above findings should not discourage the use of these valuable techniques in the elderly, but the evidence does not support their use to minimize pulmonary complications.…”

Section: Intraoperative and Postoperative Analgesiamentioning

confidence: 95%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

145

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Purpose: This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure.Source: A MEDLINE-based English-language literature search was undertaken for the period 1966-2006, and an EMBASE search covered the overlapping period 1988-2006. Selected articles were limited to those applying to elderly subjects/patients. Principal findings:Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population. Conclusion:Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery. Objectif

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Section: Intraoperative and Postoperative Analgesiamentioning

confidence: 95%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

145

View full text Add to dashboard Cite

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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%

“…[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. There was no overall difference in death or major complications in 1021 patients randomized to receive general anesthesia/opioid analgesia or combined general/epidural anesthesia and analgesia for intra-abdominal aortic, gastric, biliary, or colon surgery.…”

Section: Anesthetic Considerations and Intraoperative 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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“…Our study was designed as a prospective audit investigating the best possible treatment for our patients to achieve the highest possible rate of success for immediate extubation. Maintenance of body temperature was considered a key factor; TEA was considered another key factor based on the literature that suggested excellent pain relief and shorter extubation times with TEA 19 compared to conventional techniques. PCA was reserved for patients, who either did not consent for TEA or were on anticoagulant therapy for the treatment of unstable angina.…”

Section: Résultats : On a Pu Extuber 95 Patients Pendant Les 25 Premimentioning

confidence: 99%

Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epiduralbased anesthesia

Hemmerling

Prieto

Choinière

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the feasibility of immediate extubation after off-pump coronary artery bypass grafting (OPCAB) using opioid based analgesia or high thoracic epidural analgesia (TEA) and compare postoperative analgesia with continuous TEA vs patient-controlled analgesia (PCA).M Me et th ho od ds s: : One hundred consecutive patients undergoing OPCAB were included in this prospective audit. After induction of anesthesia using fentanyl 2 to 5 µg·kg -1 , propofol 1 to 2 mg·kg -1 and endotracheal intubation facilitated by rocuronium, anesthesia was maintained using sevoflurane titrated according to bispectral index monitoring. Perioperative analgesia was provided by TEA (n = 63) at the T3/T4 interspace or T4/T5 interspace using bupivacaine 0.125% 8 to 14 mL·hr -1 and repetitive boluses of bupivacaine 0.25% during surgery. In patients who were fully anticoagulated or refused TEA, perioperative analgesia was achieved by iv fentanyl boluses (up to 15 µg·kg -1 ) and remifentanil 0.1 to 0.2 µg·kg -1 ·min -1 , followed by morphine PCA after surgery (n = 37). Maintenance of body temperature was achieved by a heated operating room and forced-air warming blankets.R Re es su ul lt ts s: : Ninety-five patients were extubated within 25 min after surgery (PCA, n = 33; TEA, n = 62). Five patients were not extubated immediately because their core temperature was lower than 35°C. One patient was re-intubated because of agitation (TEA group); one was re-intubated because of severe pain and morphine-induced respiratory depression (PCA group). Pain scores were low after surgery, with pain scores in the TEA group being significantly lower immediately, at six hours, 24 hr and 48 hr after surgery (P < 0.05).C Co on nc cl lu us si io on n: : Immediate extubation is possible after OPCAB using either opioid-based analgesia or TEA. TEA provides significantly lower pain scores after surgery in comparison to morphine PCA. Objectif : Vérifier la faisabilité de l'extubation immédiatement après un pontage aortocoronarien à coeur battant (PACCB) en utilisant une analgésie avec opioïdes ou une analgésie péridurale thoracique (APT), et comparer l'analgésie postopératoire avec APT continue ou analgésie auto-contrôlée (AAC). Méthode : Cent patients consécutifs devant subir un PACCB ont été inclus dans un audit prospectif. Après l'induction de l'anesthésie avec

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Double-masked Randomized Trial Comparing Alternate Combinations of Intraoperative Anesthesia and Postoperative Analgesia in Abdominal Aortic Surgery

Cited by 193 publications

References 0 publications

Review article: Age related alterations in respiratory function — anesthetic considerations

Review article: Age related alterations in respiratory function — anesthetic considerations

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

Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epiduralbased anesthesia

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