Anesthetic management of abdominal aortic surgery: a retrospective review of perioperative complications.
The incidence of perioperative complications was retrospectively reviewed in 103 patients who underwent replacement of the abdominal aorta from 1981 to 1987. Eighty-nine of the patients had associated systemic diseases, with hypertension being the most frequent (63%). Ischemic heart disease and cerebrovascular disease had an incidence of 12% and 13%, respectively. Combined anesthesia with lumbar epidural and light general anesthesia (group I) was compared with general anesthesia alone (group II). Excluding patients with a ruptured aneurysm, 39 of 97 patients (40%) had associated intraoperative hypertension, which was related to the presence of preexisting hypertension, but not to the anesthetic technique. Postoperative hypertension also occurred in 39 patients, but the incidence was not related to preoperative hypertension. More patients in group I had postoperative hypertension than in group II (P less than 0.05). In group I, 6 of 22 patients who received epidural morphine developed hypertension compared to 23 out of 37 patients not given epidural morphine (P less than 0.01). There were no significant differences in the overall complication rate between the two groups; however, the incidence of liver dysfunction was significantly higher in group II. Deterioration in renal function occurred in 6 patients, but with no difference between groups. There were three perioperative deaths (2.9%), with two of them resulting from cerebrovascular accidents in patients with a history of cerebrovascular disease. The overall morbidity and mortality were independent of the anesthetic technique.
Haku
E
E
Department of Anesthesiology, Kobe City General Hospital, Japan.
Hayashi
M
M
Kato
H
H
D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D000769:Anesthesia, Inhalation / Q000706:statistics & numerical data; D001012:Aorta, Abdominal / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate; D013997:Time Factors