Key result
Epidural analgesia with light balanced general anesthesia reduced postoperative reinfarction compared to neurolept anesthesia (4% vs 23%) in patients undergoing major vascular surgery after MI.
Why the study?
Does epidural analgesia combined with light balanced general anesthesia reduce postoperative reinfarction and intraoperative circulatory morbidity in patients undergoing major vascular surgery within three months of a myocardial infarction compared to neurolept anesthesia?
RCT (n=45)
Randomly assigned
Does epidural analgesia combined with light balanced general anesthesia reduce postoperative reinfarction and intraoperative circulatory morbidity in patients undergoing major vascular surgery within three months of a myocardial infarction compared to neurolept anesthesia?
Absolute Event Rate: 4% vs 23%
Epidural analgesia combined with light balanced general anesthesia improves intraoperative cardiovascular stability and significantly reduces postoperative reinfarction rates in high-risk patients undergoing major vascular surgery.
Supports epidural-light balanced GA over neurolept anesthesia for post-MI vascular surgery; reinforces regional techniques in high-risk perioperative cardiac patients.
The coronary hemodynamic effects of neurolept anesthesia (NLA II) [fentanyl 15 μg/kg, droperidol 200 μg/kg, and 70% N20], 1% end-tidal halothane, 1% end-tidal isoflurane, and 1.4% end-tidal enflurane were investigated in 34 patients with ischemic heart disease. All anesthetics induced reduction in coronary perfusion pressure, most pronounced during enflurane. Oxygen demand was met by supply during NLA II. Combined findings of unchanged or decreasing coronary vascular resistance with decreased myocardial oxygen extraction indicate that halothane, isoflurane, and enflurane induced coronary vasodilatation. Isoflurane and enflurane were approximately equipotent and more powerful than halothane. Ischemic ST-T segment changes were observed in approximately half the isoflurane and enflurane patients likely due to a combination of decreased coronary perfusion pressure and coronary steal effects. The coronary hemodynamic effects of surgical stimulation were studied in 13 patients during NLA II and enflurane anesthesia. Ten minutes of abdominal surgery induced coronary vasoconstriction in both groups, most pronounced with enflurane anesthesia and closely related to increased myocardial extraction of norepinephrine. It is suggested that droperidol may modify the coronary vasoconstrictor response to surgery. Addition of epidural analgesia during surgery in the NLA II group abolished the constrictor response to surgery. Forty-five patients undergoing major vascular surgery within three months of a myocardial infarction were investigated with regards to intraoperative circulatory morbidity and postoperative reinfarction rate. The patients were randomly assigned to NLA II or epidural analgesia combined with light balanced general anesthesia (ED). The ED patients had significantly better intraoperative cardiovascular stability with lower incidence of ischemic events and lower reinfarction rate (4% versus 23%), whereas postoperative mortality rates were equal. It is concluded that the combination of epidural analgesia and light balanced general anesthesia is safe and provides excellent intraoperative cardiovascular stability.
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Reiz et al. (1982) conducted an RCT in Recent myocardial infarction undergoing major vascular surgery (n=45). Epidural analgesia combined with light balanced general anesthesia (ED) vs. Neurolept anesthesia (NLA II) was evaluated on Postoperative reinfarction rate. Epidural analgesia with light balanced general anesthesia reduced postoperative reinfarction compared to neurolept anesthesia (4% vs 23%) in patients undergoing major vascular surgery after MI.
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