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Effects of anesthetic technique on myocardial wall motion abnormalities during abdominal aortic surgery.

Abstract：

OBJECTIVE:To assess the impact of regional supplemented general anesthesia (RSGEN) on regional myocardial function during abdominal aortic surgery (AAS). DESIGN:Prospective randomized study. SETTING:Single academic medical center. PARTICIPANTS:Seventy-three patients scheduled for infrarenal aortic aneursymectomy. INTERVENTIONS:Patients received standardized intraoperative anesthetic management consisting of either general anesthesia (GA; n = 37) or general anesthesia supplemented by epidural anesthesia (RSGEN; n = 36). MEASUREMENTS AND MAIN RESULTS:Hemodynamic measurements and transesophageal echocardiograms (TEE) were obtained at eight intraoperative times. The electrocardiogram (ECG) was continuously recorded using Holter monitoring. Of the 56 patients with interpretable TEE recordings, 8 of 30 (27%) GA patients and 7 of 26 (27%) RSGEN patients developed new segmental wall motion abnormalities (SWMAs). There was no treatment effect on either the incidence (p = 0.23) or the intensity (p = 0.34) of SWMAs. Cross-clamping of the aorta was associated with the onset of new SWMAs (odds ratio, 8.2; 95% CI, 1.1 to 64; p = 0.04). Among the 63 patients with interpretable Holter recordings, 9 of 34 (26%) GA patients and 9 of 29 (31%) RSGEN patients exhibited intraoperative ischemia. There was no treatment effect on the incidence (p = 0.22) or intensity (p = 0.67) of ECG ischemia. CONCLUSION:Despite providing modest hemodynamic depression, RSGEN did not reduce the incidence or intensity of either regional myocardial dysfunction or ECG ischemia. New SWMAs were temporally associated with cross-clamping of the aorta and tended to resolve with unclamping.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Dodds TM,Burns AK,DeRoo DB,Plehn JF,Haney M,Griffin BP,Weiss JE,Stukel TA,Yeager MP

doi

10.1016/s1053-0770(97)90201-9

subject

Has Abstract

pub_date

1997-04-01 00:00:00

pages

129-36

issue

2

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(97)90201-9

journal_volume

11

pub_type

临床试验,杂志文章,随机对照试验

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