Kosuyolu Heart J 2013;16(1)
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Kosuyolu Heart J 2013;16(1):25-31 - doi: 10.5578/kkd.4139
Endovasküler Aortik Rekonstrüksiyonlarda Anestezi Yaklaşımı

Anesthesia Approach in Endovascular Aortic Reconstruction

Funda Gümüş1, Adil Polat2, Bora Farsak3, Ayşin Alagöl1


1 Department of Anesthesiology and Reanimation, Bagcilar Training and Research Hospital, Istanbul, Turkey

2 Department of Cardiovascular Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey

3 Department of Cardiovascular Surgery, Faculty of Meram Medicine, Selcuk University, Konya, Turkey

ABSTRACT

Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.

Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team's preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.

Results: Thirteen (86.7%) cases were male and 2 (13.3%) female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7%) cases had infrarenal abdominal aortic aneurysm and 2 (13.3%) had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes' measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0%) patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia). The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.

Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

Key Words: Aortic aneurysm; endovascular procedures; anesthesia.

Received: 12.07.2012 Accepted: 10.09.2012

Correspondence

Dr. Funda Gümüş

İstanbul Bağcılar Eğitim ve

Araştırma Hastanesi, Anesteziyoloji ve

Reanimasyon Kliniği

İstanbul-Türkiye

e-posta: fgumus@hotmail.com

Endovasküler Aortik Rekonstrüksiyonlarda Anestezi Yaklaşımı

Endovasküler Aortik Rekonstrüksiyonlarda Anestezi Yaklaşımı

Anesthesia Approach in Endovascular Aortic Reconstruction

Funda Gümüş1, Adil Polat2, Bora Farsak3, Ayşin Alagöl1


1 İstanbul Bağcılar Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye

1 Department of Anesthesiology and Reanimation, Bagcilar Training and Research Hospital, Istanbul, Turkey

2 İstanbul Bağcılar Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Bölümü, İstanbul, Türkiye

2 Department of Cardiovascular Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey

3 Selçuk Üniversitesi Meram Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Konya, Türkiye

3 Department of Cardiovascular Surgery, Faculty of Meram Medicine, Selcuk University, Konya, Turkey

ÖZET

Giriş: Hastanemizde yeni başlayan endovasküler aort rekonstrüksiyonu olgularında uyguladığımız anestezi tekniklerini değerlendirerek ilk sonuçlarımızı inceledik.

Hastalar ve Yöntem: 2010-2011 yılları arasında elektif ve acil endovasküler aort rekonstrüksiyonu uygulanan 15 olgunun peroperatif verileri oluşturduğumuz veri tabanında toplandı. Uygulanacak anestezi yöntemi, olguların risk faktörleri değerlendirilerek, cerrahi ekiple görüşülerek, aort patolojisinin yeri, tipi, operasyon ve öngörülen cerrahi süre belirlenerek planlandı. Lokal ve genel anestezi uygulanan grupların değerleri karşılaştırıldı.

Bulgular: Olguların 13 (%86.7)'ü erkek ve 2 (%13.3)'si kadın idi. Olguların 11'i ASA III idi. Ortalama yaşları 64.5 ± 14.0 (36-81) idi. Gruplara göre olguların demografik özellikleri, ASA durumları, eşlik eden ek hastalıkların karşılaştırmalarında anlamlı bir fark saptanmadı. On beş olgudan, 13 (%86.7)'üne infrarenal abdominal aort anevrizması ve 2 (%14.3)'sine Tip III aort disseksiyonu sebebiyle endovasküler aort rekonstrüksiyonu uygulandı. Diyastolik arter basınçları 20 ve 40. dakika ölçümlerinde lokal anestezi grubunda daha yüksek idi. Ortalama arter basınçları ise 40 ve 100. dakikalar ile greft açılırken anlamlı olarak genel anestezi grubunda daha düşük olarak hesaplandı. Postoperatif mortalite 3 (%20.0) hastada gelişti. Her üç hastaya da genel anestezi altında işlem uygulandı. Üç hasta da acil olarak işleme alınmıştı. Postoperatif morbidite genel anestezi uygulanmış olan dört hastada gelişti. Bu hastalardan üçünde mortalite gelişti (akut böbrek yetmezliği, çoklu organ yetmezliği ve pnömoni). Diğer hastada postoperatif birinci günü atriyal fibrilasyon gelişti ve amiodaron infüzyonu ile sinüs ritmine döndü.

Sonuç: Endovasküler aort rekonstrüksiyon genel ve lokal anestezi ile güvenle uygulanabilen açık cerrahiye kıyasla daha az invazif bir işlemdir. Genel anestezi, sağladığı daha iyi hemodinamik kontrol açısından tercih edilebilir. 

Anahtar Kelimeler: Aort anevrizması; endovasküler girişimler; anestezi.

Geliş Tarihi: 12.07.2012 Kabul Tarihi: 10.09.2012

ABSTRACT

Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.

Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team's preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.

Results: Thirteen (86.7%) cases were male and 2 (13.3%) female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7%) cases had infrarenal abdominal aortic aneurysm and 2 (13.3%) had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes' measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0%) patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia). The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.

Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

Key Words: Aortic aneurysm; endovascular procedures; anesthesia.

Received: 12.07.2012 Accepted: 10.09.2012

Yazışma Adresi/Correspondence

Dr. Funda Gümüş

İstanbul Bağcılar Eğitim ve

Araştırma Hastanesi, Anesteziyoloji ve

Reanimasyon Kliniği

İstanbul-Türkiye

e-posta: fgumus@hotmail.com

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