Local plus sedoanalgesia or spinal analgesia in endovascular aortic aneurysm repair experiences in a single center

Year 2021, Volume: 3 Issue: 2, 120 - 123, 24.04.2021

Mevlüt Doğukan Öznur Uludag Mehmet Duran Murat Abdulhamit Ercişli Kıymet Ceyhan Cengiz Güven Ayşe Baysal

https://doi.org/10.38053/acmj.860076

Abstract

Aim: In this study, we aimed to discuss the local anesthesia + sedo-analgesia (LA-SA) and spinal anesthesia methods applied during Endovascular Aortic Repair (EVAR) by retrospectively comparing the patients' data
Materials and Methods: Our study was carried out by retrospectively evaluating the data of 36 patients who underwent endovascular surgery for aortic aneurysm between 1 January 2013 and 31 December 2018. Three cases who were applied general anesthesia were not included in the study. The patients included in the study were divided into two groups according to the anesthesia method as LA-SA group (Group 1, n = 19) and spinal anesthesia group (Group 2, n = 14).. This study was planned as a retrospective observational controlled study. Demographic data, comorbidities, American Anesthesiologists Association (ASA) risk classification scores, mortality rates, duration of anesthesia and surgery, length of stay in the hospital and intensive care unit, and laboratory values were analyzed.
Results: In our study, the mean age of 33 patients who underwent EVAR procedure was 69.04 ± 13 (32-86). Local anesthesia + sedo-analgesia was applied to 19 (52.7%) patients and spinal anesthesia was applied to 14 (38.8%) patients. No significant difference was found between demographic data, comorbidities and smoking rates in both groups. (Table 1). ). The length of stay in the hospital and the intensive care unit and the rates of death before discharge were similar in both groups (P = 0.22) (. (P = 0.15). (P = 0.73), while the duration of anesthesia and operation The durations were statistically shorter in the localanesthesia + sedo-analgesia group, respectively (P = 0.001) and (P = 0.004). Laboratory examinations of both groups were similar.
Conclusion: For arterial stents requiring percutaneous implantation, LA-SA provides a safe anesthesia method with stable hemodynamics, less invasive intervention and shorter operation times than neuraxial anesthesia.

Keywords

Endovascular Aortic Repair, local anesthesia + sedo-analgesia, spinal anesthesia

References

• Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991; 5: 491-9.
• Jordan WD, Alcocer F, Wirthlin DJ, Westfall AO, Whitley D. Abdominal aortic aneurysms in "high-risk" surgical patients: comparison of open and endovascular repair. Ann Surg. 2003; 237: 623-9.
• Numan F, Gülşen F, Arbatlı H, Cantaşdemir M, Solak, S. Aort anevrizmalarının endovasküler tedavisinde yeni ufuklar. Türk Göğüs Kalp Damar Cerrahisi Derg 2011; 19: 27-32.
• Gürbüz A, Özsöyler İ, Yılık L, Güneş T, Aksun M, Uluç E. Torakal ve torakoabdominal aort anevrizmalarının tedavisinde cerrahi ve endovasküler cerrahi tekniklerin birlikte kullanımı. Turk Gogus Kalp Dama, 2008; 16: 146-9.
• Gümüş F, Polat A, Farsak B, Alagöl A. Endovasküler aortik rekonstrüksiyonlarda anestezi yaklaşımı. Koşuyolu Kalp Derg 2013; 16: 25-31.
• Elisha S, Nagelhout J, Heiner J, Gabot M. Anesthesia case management for endovascular aortic aneurysm repair. AANA J. 2014; 82: 145-52.
• Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg. 2006; 44: 16-21.
• 8- Harky A, Grafton-Clarke C, Chan J. Is local anaesthesia superior to general anaesthesia in endovascular repair of abdominal aortic aneurysm? Interact Cardiovasc Thorac Surg 2019; 29: 599-603.
• Armstrong RA, Squire YG, Rogers CA, Hinchliffe RJ, Mouton R. Type of Anesthesia for Endovascular Abdominal Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth 2019; 33: 462-71.
• Edwards MS, Andrews JS, Edwards AF, et al. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg. 2011; 54: 1273-82..
• Henretta JP, Hodgson KJ, Mattos MA, et al. Feasibility of endovascular repair of abdominal aortic aneurysms with local anesthesia with intravenous sedation. J Vasc Surg 1999; 29: 793-8.
• Mathes DD, Kern JA. Continuous spinal anesthetic technique for endovascular aortic stent graft surgery. J Clin Anesth 2000; 12: 487-90.
• Lachat M, Pfammatter T, Turina M. Transfemoral endografting of thoracic aortic aneurysm under local anesthesia: a simple, safe and fast track procedure. Vasa 1999; 28: 204-6.
• Türktan M, Göçen U. Endovasküler aort tamirinde anestezi yaklaşımları: tek merkez deneyimi. Cukurova Med J 2019; 44: 1256-61.
• Bettex DA, Lachat M, Pfammatter T, Schmidlin D, Turina MI, Schmid ER. To compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). Eur J Vasc Endovasc Surg 2001; 21: 179-84.
• Rössel T, Paul R, Richter T, et al. Management bei endovaskulären Gefäßeingriffen (Management of anesthesia in endovascular interventions). Anaesthesist. 2016; 65: 891-910.
• Llau JV, De Andrés J, Gomar C, Gómez-Luque A, Hidalgo F, Torres LM. Anticlotting drugs and regional anaesthetic and analgesic techniques: comparative update of the safety recommendations. Eur J Anaesthesiol 2007; 24: 387-98.
• Waurick K, Riess H, Van Aken H, Kessler P, Gogarten W, Volk T. S1- Leitlinie Rückenmarksnahe regionalanästhesien und thrombembolieprophylaxe/antithrombotische medikation. Anästh Intensivmed 2014; 55: 464-4.