General versus epidural anesthesia for femoral-popliteal bypass surgery.
This study examines whether epidural anesthesia is more effective than general anesthesia using an inhalation agent in controlling cardiovascular responses during femoral-popliteal bypass surgery. Nineteen patients were randomized into two groups: general anesthesia (n = 10) and epidural anesthesia (n = 9). The patients who underwent general anesthesia received sodium pentothal and succinylcholine for induction of anesthesia and 60% N2O, 40% O2, and 1% to 1.5% isoflurane for maintenance. Fifteen minutes before extubation, the patients received morphine sulfate 0.05 mg/kg intravenously (IV). The group that underwent epidural anesthesia received anesthesia to T-10 (through a catheter placed in the L4-5 interspace using 3% 2-chloroprocaine). Thirty minutes after the last dose, 0.05 mg/kg IV was administered. Hemodynamic variables were recorded at selected intervals during the operation and for 60 minutes in the recovery room. In the general anesthesia group, mean arterial pressure (MAP) and rate pressure product (RPP) significantly decreased (p less than 0.05) during the operation as compared with preoperative values. Following intubation and skin incision, 5 minutes after extubation, and after 60 minutes in the recovery room, MAP, heart rate (HR), and RPP were significantly greater (p less than 0.05) as compared with intraoperative periods. In the epidural anesthesia group, there were clinically important decreases in MAP and RPP after reaching T-10 and skin incision. The general anesthesia patients showed higher MAP, HR, and RPP 5 minutes after extubation and after 60 minutes in the recovery room. Epidural anesthesia patients showed stable hemodynamic patterns throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
M C
MC
Damask
C
C
Weissman
G
G
Todd
D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic