Annals of Vascular Surgery

, Volume 3, Issue 3, pp 214–219 | Cite as

Neuroleptanesthesia versus thoracic epidural anesthesia for abdominal aortic surgery

  • F. Bonnet
  • C. Touboul
  • A. M. Picard
  • J. Vodinh
  • J-P. Becquemin
Original Articles
  • 9 Downloads

Abstract

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 words

Neuroleptanesthesia anesthesia abdominal aorta 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    GOLDMAN L, CALDERA DL, NASSBAUMS SR, SOUTHWICK FS, CAPLAN CH, NOLAN J, CARABELLO B, SLATTER EE. Multifunctional index of cardiac risk in non cardiac surgical procedures.N Engl J Med 1977;297:845–850.PubMedGoogle Scholar
  2. 2.
    WATERS J, WILKINSON C, GOLMAN M, SCHOEPPEL S, LINDE HW, BRUNNER EM. Evaluation of cardiac risk in non cardiac surgical patients.Anesthesiology 1981;55:A343.CrossRefGoogle Scholar
  3. 3.
    MELOCHE R, POTTECHER T, AUDET J, DUFRESNE O, LE PAGE C. Hemodynamic changes due to clamping of the abdominal aorta.Canad Anaesth Soc J 1977;24:20–33.CrossRefPubMedGoogle Scholar
  4. 4.
    SILVERSTEIN PR, CALDERA DL, CALLEN DJ, DAVISON JK, DARLING RC, EMERSON CW. Avoiding the hemodynamic consequences of aortic cross clamping and unclamping.Anesthesiology 1979;50:462–466.CrossRefPubMedGoogle Scholar
  5. 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
  6. 6.
    KALMAN PG, WELLWOOD M, WEISEL RD, MORLEY-FORSTA PK, TEASDALE SJ, IVANOV J, JOHNSTON W, MclAUGHLIN PR, BAIRD RJ, CAIN JP, WALKER PM. Cardiac dysfunction during abdominal aortic operation: the limitations of pulmonary wedge pressures.J Vasc Surg 1986;3:773–781.CrossRefPubMedGoogle Scholar
  7. 7.
    PETERSON A, BRANDT D, KIRSH MM. Nitroglycerin infusion during infrarenal aortic cross-clamping in dogs: An experimental study.Surgery 1978;84:216–223.PubMedGoogle Scholar
  8. 8.
    REIZ S, PETER T, RAIS O. Hemodynamic and cardiometabolic effects of infrarenal aortic and common iliac artery unclamping in man—an approach to optimal volume loading.Acta Anaesth Scand 1979;23:579–586.CrossRefPubMedGoogle Scholar
  9. 9.
    ZAIDAN JR, GUFFIER AV, PERDUE G, SMITH R, McNEILL DC. Hemodynamics of intravenous nitroglycerin during aortic clamping.Arch Surg 1982;117:1285–1288.PubMedGoogle Scholar
  10. 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
  11. 11.
    LUNN JK, DANNEMILLER FJ, STANLEY TH. Cardiovascular responses to clamping of the aorta during epidural and general anesthesia.Anaesth Analg 1979;58:372–376.CrossRefGoogle Scholar
  12. 12.
    REIZ S, BALFORS E, HAGGMARK S, NATH S, RYDVALL A, TRUEDSSON H. Myocardial oxygen consumption and coronary hemodynamics during fentanyl-droperidol-nitrous oxide anesthesia in patients with ischemic heart disease.Acta Anaesth Scand 1981;25:286–292.CrossRefPubMedGoogle Scholar
  13. 13.
    HOTVEDT R, PLATON ES, REFSUM H. Effect of thoracic epidural anesthesia on cardiovascular function and plasma concentration of free-fatty acids and catecholamines in the dog.Acta Anaesth Scand 1984;28:132–137.CrossRefPubMedGoogle Scholar
  14. 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
  15. 15.
    KLASSEN GA, BRAMWELL RS, BROMAGE PR, ZBOROWSKA SLUIS DT. Effect of acute sympathectomy by epidural anesthesia on the coronary circulation.Anesthesiology 1980;52:8–15.CrossRefPubMedGoogle Scholar
  16. 16.
    REIZ S, NATH S, PONTEN E. Hemodynamic effects of prenalterol, a beta 1 adrenoreceptor agonist in hypotension induced by high thoracic epidural block in man.Acta Anaesth Scand 1979;23:93–96.CrossRefPubMedGoogle Scholar
  17. 17.
    BUFFINGTON CW. The pressure-ratio predicts myocardial ischemia in the presence of severe coronary stenosis.Anesthesiology 1985;65:A-69.Google Scholar
  18. 18.
    BRISMAR B, BERGENWALD L, GRONESTRAND K, JORFELDT L, JUHLIN-DANNFELT A. The cardiovascular effects of neuroleptanalgesia.Acta Anaesth Scand 1977;21:100–108.CrossRefPubMedGoogle Scholar
  19. 19.
    SIVARAJAN M, ARMORY DW, LINDBLOOM LE, SCHWETTMANN RS. Systemic and regional blood flow changes during spinal anesthesia in the rhesus monkey.Anesthesiology 1975;45:78–88.CrossRefGoogle Scholar
  20. 20.
    SHIMOSATO S, ETSEN BE. The role of venous system in cardiocirculatory dynamics during spinal and epidural anesthesia in man.Anesthesiology 1969;50:619–628.CrossRefGoogle Scholar
  21. 21.
    REIZ S, NATH S, PONTEN E, FRIEDMAN A, BACKLAND U, OLSSON B, RAIS O. Effects of thoracic epidural block and beta-1-adrenoreceptor agonist prenaltoerol on the cardiovascular response to infrarenal aortic cross-clamping in man.Acta Anaesth Scand 1979;23:395–403.CrossRefPubMedGoogle Scholar
  22. 22.
    BONICA JJ, BERGES PV, MORIKAWA KI. Circulatory effects of epidural block I: effects of level of analgesia and dose of lidocaine.Anesthesiology 1970;33:619–627.CrossRefPubMedGoogle Scholar
  23. 23.
    BIBER B, MARTINER J. Hemodynamic consequences of defense area stimulation and afferent somatic nerve stimulation during fentanyl nitrous oxide anesthesia. Modifying effects of droperidol.Acta Anaesth Scand 1981;25:336–343.CrossRefPubMedGoogle Scholar
  24. 24.
    REIZEN MF, HORRIGAN RW, FRAZER BM. Anesthetic doses blocking adrenergic (stress) and cardiovascular response to incision MAC BAR.Anesthesiology 1981;54:390–3988.CrossRefGoogle Scholar
  25. 25.
    BUSH HL, LO TOWNE JB GERFO FW, WEISEL RD, MANNICK JA, HECHTMAN HB. Assessment of myocardial performance and optimal volume loading during elective abdominal aortic aneurysm resection.Arch Surg 1977;112:1301–1306.PubMedGoogle Scholar
  26. 26.
    DUNN E, PRAGER RL, FRY W, KIRSH MM. The effect of abdominal aortic cross-clamping on myocardial function.J Surg Res 1977;22:463–468.CrossRefPubMedGoogle Scholar
  27. 27.
    KAPLAN R, WELLO PH. Early diagnosis of myocardial ischemia using the pulmonary artery catheter.Anesth Analg 1981;60:789.PubMedGoogle Scholar
  28. 28.
    SUNDBERG A, WATTWIL M, WIKLUND L. Hemodynamic effects of intravenous bupivacaine during high thoracic epidural anesthesia.Acta Anaesth Scand 1987;31:143–1477.CrossRefPubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1989

Authors and Affiliations

  • F. Bonnet
    • 1
    • 2
    • 3
  • C. Touboul
    • 1
    • 2
    • 3
  • A. M. Picard
    • 1
    • 2
    • 3
  • J. Vodinh
    • 1
    • 2
    • 3
  • J-P. Becquemin
    • 1
    • 2
    • 3
  1. 1.Department of AnesthesiaHôpital Henri MondorCreteilFrance
  2. 2.Department of Intensive CareHôpital Henri MondorCreteilFrance
  3. 3.Department of Vascular SurgeryHôpital Henri MondorCreteilFrance

Personalised recommendations