Neuroleptanesthesia versus thoracic epidural anesthesia for abdominal aortic surgery
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The hemodynamic consequences of abdominal aortic surgery with infrarenal crossclamping were studied in 21 patients randomized in two groups. In Group I (11 patients), neuroleptanesthesia was utilized, while Group II (10 patients) received thoracic epidural anesthesia at the T8-9 level. Hemodynamic measurements were performed using Swan-Ganz catheters during the surgical procedures in all patients, with special attention to the periods of clamping and unclamping of the abdominal aorta. The thoracic epidural anesthesia group was characterized by greater hemodynamic stability during surgery, while patients in the neuroleptanesthesia group had significant lability of blood pressure, heart rate, and cardiac index. Nevertheless, in the two groups of patients, it is suggested that cardiac function was unfitted to the tissue oxygen demand after unclamping of the aortic prosthesis because the saturation in oxygen of the mixed venous blood and an increase in arteriovenous difference in oxygen were documented. These results point out that, whatever the anesthesia technique, the critical period in abdominal surgery could be aortic unclamping.
Key wordsNeuroleptanesthesia anesthesia abdominal aorta
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- 5.ATTIA RR, MURPHY JO, SNIDER M, LAPPAS DG, DARLING RC, LOWENSTEIN E. Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease.Circulation 1976;55:961–965.Google Scholar
- 10.REIZ S, BALFORS E, SORENSON MB, HAGGMARK S, NYHMAN H. Coronary hemodynamic effects of general anesthesia and surgery modification by epidural analgesia in patients with ischemic heart disease.Regional Anesthesia 1982;7:S8–18.Google Scholar
- 14.VICK MOH, OTTESEN S, RENCK H. Cardiac effects of thoracic epidural analgesia before and during acute coronary artery occlusion in open-chest dogs.Scand J Clin Lab Invest 29 1978;58:746–757.Google Scholar
- 17.BUFFINGTON CW. The pressure-ratio predicts myocardial ischemia in the presence of severe coronary stenosis.Anesthesiology 1985;65:A-69.Google Scholar