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Endovascular Abdominal Aortic Aneurysm Repair under General Anesthesia Does Not Decrease Perioperative Myocardial Ischemic Events Compared with Open Repair

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Open Journal of Anesthesiology 2013年第2期3卷 84-89页

作者： Noriko Nanishi Ken Yamaura Katsuyuki Matsushita Kozaburo Akiyoshi yuji karashima Midoriko Higashi Sumio Hoka Department of Anesthesiology and Critical Care Graduate School of Medicine Kyushu University Fukuoka Department of Anesthesiology and Critical Care Graduate School of Medicine Kyushu University Fukuoka Japan Department of Anesthesiology and Critical Care Kyushu University Hospital Fukuoka Japan. Operating Rooms Kyushu University Hospital Fukuoka Japan

Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) is a common procedure for abdominal aortic aneurysm (AAA), based on minimal invasiveness compared with open surgical repair (OSR). However, general anesthesia can cause considerable perturbations in patients with AAA undergoing operative repair. The aim of this study was to compare the incidence of myocardial ischemic events in association with hemodynamic changes during EVAR and OSR under general anesthesia. Methods: We retrospectively reviewed the anesthetic and medical records of patients who underwent elective abdominal aortic aneurysm repair. ST segment changes on electrocardiography and hemodynamic changes were reviewed by the attending physicians. Results: Among 120 patients, EVAR and OSR were performed in 81 and 39 patients, respectively. There were no significant differences in preoperative morbidity between the two groups. The amount of estimated blood loss was significantly lower in EVAR than OSR. The incidence of ST?segment changes in the two groups (EVAR: 16%, OSR: 23%) was not statistically different. ST segment changes occurred mainly postoperatively at resolution of anesthesia in EVAR, compared with intraoperatively in OSR. ST segment changes were mostly accompanied by tachycardia in EVAR patients, whereas they were associated with hypotension in OSR. Conclusion: Our results demonstrated a comparable incidence of perioperative ST segment changes under general anesthesia in EVAR and OSR. Patients who undergo EVAR and develop tachycardia are at risk of myocardial ischemia at resolution of anesthesia.

关键词： Abdominal Aortic Aneurysm (AAA) Anesthesia General Vascular Surgery EVAR Complication Cardiac Myocardial Ischemia

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