Effects of anesthetic technique on myocardial wall motion abnormalities during abdominal aortic surgery.
OBJECTIVE
To assess the impact of regional supplemented general anesthesia (RSGEN) on regional myocardial function during abdominal aortic surgery (AAS).


METHODS
Prospective randomized study.


METHODS
Single academic medical center.


METHODS
Seventy-three patients scheduled for infrarenal aortic aneursymectomy.


METHODS
Patients received standardized intraoperative anesthetic management consisting of either general anesthesia (GA; n = 37) or general anesthesia supplemented by epidural anesthesia (RSGEN; n = 36).


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.


CONCLUSIONS
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.
Dodds
T M
TM
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Burns
A K
AK
DeRoo
D B
DB
Plehn
J F
JF
Haney
M
M
Griffin
B P
BP
Weiss
J E
JE
Stukel
T A
TA
Yeager
M P
MP
D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001012:Aorta, Abdominal / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000517:prevention & control*