title: The feasibility of epidural anesthesia without endotracheal intubation for abdominal surgery in patients with collagen diseases.
abstract: OBJECTIVE
  Patients with collagen diseases are generally regarded as high-risk surgical candidates.
  
  
  METHODS
  To evaluate the feasibility of epidural anesthesia and to determine the risk factors in abdominal surgery for patients with collagen diseases, 20 patients with collagen diseases who underwent elective abdominal surgery were examined for their surgical outcomes and clinical characteristics. Among the 20 cases, 12 received epidural anesthesia alone without endotracheal intubation, 3 received general anesthesia only, 4 received general anesthesia with epidural anesthesia and one received lumbar anesthesia.
  
  
  RESULTS
  Only one patient receiving epidural anesthesia died after operation. The mortality in patients receiving epidural anesthesia was 8.3% (1/12) while the overall mortality was 5.0% (1/20). No significant difference was observed either in the mortality or incidence of postoperative complications among the 4 groups according to the method of anesthesia. Patients with a dysfunction of the vital organs more often had postoperative complications than those without a dysfunction of the vital organs (p = 0.043).
  
  
  CONCLUSIONS
  Although only a small number of patients were included in this study, these results suggested that 1) elective abdominal surgery can be as safely performed under epidural anesthesia alone as with general anesthesia even for patients with collagen diseases, and 2) the patients with collagen diseases, who preoperatively showed a dysfunction of the vital organs, might be at a higher risk for abdominal surgery.
authors.affiliation: Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nakashima
authors.forename: H
authors.initials: H
authors.lastname: Ueo
authors.forename: N
authors.initials: N
authors.lastname: Karimine
authors.forename: T
authors.initials: T
authors.lastname: Asoh
authors.forename: M
authors.initials: M
authors.lastname: Mori
authors.forename: T
authors.initials: T
authors.lastname: Akiyoshi
authors.forename: K
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D003095:Collagen Diseases / Q000150:complications* / Q000188:drug therapy; D004066:Digestive System Diseases / Q000150:complications* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids